PNE 111/PrepU 18, 62, 63, & 66
Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression? Decreased platelets and red blood cells Decreased sodium levels and decreased potassium levels Increased creatinine and blood urea nitrogen (BUN) Increased white blood cells and c-reactive protein (CRP)
Decreased platelets and red blood cells Explanation: Most chemotherapeutic agents cause myelosuppression (depression of bone marrow function), resulting in decreased production of blood cells. Myelosuppression decreases the number of WBCs (leukopenia), red blood cells (RBCs) (anemia), and platelets (thrombocytopenia), and increases the risk of infection and bleeding. It does not typically affect electrolytes, creatinine, BUN, and CRP levels.
The nurse manager is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, which action should the nurse manager emphasize? Use gloves and a lab coat when preparing the medication. Wash hands with an alcohol-based cleanser following administration. Dispose of the antineoplastic wastes in the hazardous waste receptacle. Adjust the dose to the client's present symptoms.
Dispose of the antineoplastic wastes in the hazardous waste receptacle. Explanation: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Dosages are not adjusted on a short-term basis. Hand and arm hygiene must be performed before and after administering the medication.
Which of the following is a characteristic of a malignant tumor? It is usually slow growing. It gains access to the blood and lymphatic channels. It demonstrates cells that are well differentiated. It grows by expansion.
It gains access to the blood and lymphatic channels. Explanation: By this mechanism, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? It prevents alopecia. It stimulates the immune system against the tumor cells. It lowers serum and uric acid levels. It treats drug-related anemia.
It lowers serum and uric acid levels. Explanation: The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurrence can be reduced with allopurinol's action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure. Allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? Throw I.V. tubing in the trash after the infusion is stopped. Disconnect I.V. tubing with gloved hands. Break needles after the infusion is discontinued. Wear disposable gloves and protective clothing.
Wear disposable gloves and protective clothing. Explanation: A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.
Which of the following would be inconsistent as a common side effect of chemotherapy? Weight gain Fatigue Alopecia Myelosuppression
Weight gain Explanation: Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.
During a client's examination and consultation, the physician keeps telling the client, "You have an abdominal neoplasm." Which statements accurately paraphrase the physician's statement? Select all that apply. "You have an abdominal malignancy." "You have an abdominal tumor." "You have a new growth of abnormal tissue in your abdomen." "You have abdominal cancer."
You have a new growth of abnormal tissue in your abdomen."You have an abdominal tumor." Explanation: New growths of abnormal tissue are called "tumors." Tumors may be benign or malignant; not all tumors are cancerous.
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include: expected chemotherapy-related adverse effects. chemotherapy exposure and risk factors. signs and symptoms of infection. reinforcement of the client's medication regimen.
chemotherapy exposure and risk factors. Explanation: The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.
What nursing intervention should the nurse prioritize to facilitate healing in a client who has suffered a hip fracture? Maintain prone positioning at all times. Place a pillow between the client's legs when turning. Administer analgesics as required. Encourage internal and external rotation of the affected leg.
Place a pillow between the client's legs when turning. Explanation: Placing a pillow between the client's legs when turning prevents adduction and supports the client's legs. Administering analgesics addresses pain but does not directly protect bone remodeling and promote healing. Rotation of the affected leg can cause dislocation and must be avoided. Prone positioning does not need to be maintained at all times.
A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? Have visitors wear dosimeters for safety. Place a chair next to the bed to allow the spouse to sit. Allow visitors to telephone only. Place the client in a private room.
Place the client in a private room. Explanation: Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.
Which of the following laboratory findings, would be identified by the nurse as the greatest risk for a cancer client scheduled for implantable port? White blood cell count 10,800/mm3 Hemoglobin 10 g/dl Platelet count 98,000/mm3 Hematocrit 36.0%
Platelet count 98,000/mm3 Explanation: Although the WBC, HGB, and HCT are all slightly outside the normal range, the platelet count is very low and places the client at risk for bleeding. This is especially a concern with a surgical procedure.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Promotion Initiation Progression Prolongation
Progression Explanation: Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.
A client who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What is the primary goal of this multidisciplinary team? Maximize the efficiency of care. Facilitate the client's adjustment to a new body image. Ensure that the client's health care is holistic. Promote the client's highest possible level of function.
Promote the client's highest possible level of function. Explanation: The multidisciplinary rehabilitation team helps the client achieve the highest possible level of function and participation in life activities. The team is not primarily motivated by efficiency, the need for holistic care, or the need to foster the client's body image, despite the fact that each of these are valid goals.
Which nursing action best demonstrates primary cancer prevention? Encouraging yearly Pap tests Teaching testicular self-examination Promoting and providing vaccines Facilitating screening mammograms
Promoting and providing vaccines Explanation: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as promoting vaccines that prevent cancer. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.
A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis? White, cottage cheese-like patches on the tongue Rust-colored sputum Red, open sores on the oral mucosa Yellow tooth discoloration
Red, open sores on the oral mucosa Explanation: The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia
A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? "I take a stool softener every morning." "I use an electric razor to shave." "I floss my teeth every morning." "I removed all the throw rugs from the house."
"I floss my teeth every morning." Explanation: A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.
A client with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the client has understood health education when the client makes what statement? "I'll stop taking my steroids when I get relief from my symptoms." "I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels." "I'll make sure to monitor my body temperature on a regular basis." "I'll try to be as physically active as possible between flare-ups."
"I'll make sure to monitor my body temperature on a regular basis." Explanation: Fever can signal an exacerbation and should be reported to the health care provider. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. As well, these drugs should not be independently adjusted by the client.
A patient is scheduled for cryoablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse? "The surgeon is going to use radiofrequency to ablate the area." "The surgeon is going to use medication to inject the area." "The surgeon is going to use liquid nitrogen to freeze the area." "The surgeon is going to use a laser to remove the area."
"The surgeon is going to use liquid nitrogen to freeze the area." Explanation: Cryoablation is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers. Chemosurgery is the use of medication. Laser surgery is the use of a laser. Radiofrequency ablation is the use of thermal energy.
A patient with a diagnosis of renal cell carcinoma is being treated with chemotherapy. During a previous round of chemotherapy, the patient's tumor responded well to treatment but the chemotherapy caused intense nausea and vomiting. How should the patient's potential nausea and vomiting be addressed during this current round of treatment? Prioritize nonpharmacological treatments over medications. Administer antiemetics if the patient vomits or believes he will soon vomit. Administer antiemetics in anticipation of the patient's nausea. Provide the patient with antiemetics at his first complaint of nausea.
Administer antiemetics in anticipation of the patient's nausea. Explanation: The prevention of chemotherapy-induced nausea and vomiting is a priority. It is inappropriate to reject pharmacological treatments or to wait until the patient experiences nausea and/or vomiting before providing medication.
A client is struggling emotionally with a recent diagnosis of lung cancer. Which nursing interventions would be most effective in helping the client deal with these emotions? Select all that apply. Assess the client's immediate support systems. Teach the client to use relaxation techniques. Encourage the client to set goals for the future. Encourage the client to make better choices.
Assess the client's immediate support systems. Encourage the client to set goals for the future. Teach the client to use relaxation techniques. Explanation: Clients diagnosed with cancer have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy lifestyle. When provided with adequate information and supported psychologically, however, clients are more likely to face their diagnosis and be involved with their care and treatment.
A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? Wearing a lead apron during direct contact with the client Applying talcum powder to the irradiated areas daily after bathing Removing thoracic skin markings after each radiation treatment Avoiding using soap on the irradiated areas
Avoiding using soap on the irradiated areas Explanation: Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.
The nurse is conducting a health education about cancer prevention to a group of adults. What menu best demonstrates dietary choices for potentially reducing the risks of cancer? Pork chops and fried green tomatoes Smoked salmon and green beans Liver, onions, and steamed peas Baked apricot chicken and steamed broccoli
Baked apricot chicken and steamed broccoli Explanation: Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited.
The nurse should teach the patient who is being radiated about protecting his skin and oral mucosa. An important teaching point would be to tell the patient to: Use an approved emollient 2 hours before the radiation to give the skin time to absorb the medication and provide a shield for damage. Apply a small ice compress to the treated area afterward to decrease localized redness, post-radiation. Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. Use an ointment, after treatment, to decrease the feeling of burning, which may last for several hours.
Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. Explanation: The patient should cleanse himself with a mild soap using his fingertips rather than a wash cloth. All the other choices will irritate the skin and fail to protect it from additional injury.
Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect? Phlebitis. Compartment syndrome. Infection. Chronic venous insufficiency.
Compartment syndrome. Explanation: Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation.
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue? Punch biopsy Excisional biopsy Incisional biopsy Needle biopsy
Excisional biopsy Explanation: Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.
A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient? Cardiac tamponade Fat emboli Spontaneous pneumothorax Pneumonia
Fat emboli Explanation: After fracture of long bones or pelvic bones, or crush injuries, fat emboli frequently form. Fat embolism syndrome (FES) occurs when fat emboli cause morbid clinical manifestations. The classic triad of clinical manifestations of FES include hypoxemia, neurologic compromise, and a petechial rash (NAON, 2007), although not all signs and symptoms manifest at the same time (Tzioupis & Giannoudis, 2011). The typical first manifestations are pulmonary and include hypoxia and tachypnea.
A client is hospitalized because a large abdominal tumor was seen on the computed tomography scan. A biopsy is ordered, and the client wants to know if "this will cause a big scar." Which type of biopsy will this client likely experience? Incisional Fine needle Needle Excisional
Incisional Explanation: An incisional biopsy is performed if the tumor is too large to be removed. An excisional biopsy is used for small, easily accessible tumors. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible. Fine needle biopsy aspirates cells rather than tissue. Needle biopsies are usually done in an outpatient setting. The biopsy type is chosen based on size, location, and whether a cancer diagnosis was confirmed. The client will have a scar and the size will depend on whether it will be performed by endoscopy or laparotomy.
A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to: Report the unexpected sign of increased appetite and weight gain. Increase her intake of calcium-rich foods. Be alarmed if she notices fluid retention. Report the unusual sign of nausea.
Increase her intake of calcium-rich foods. Explanation: One of the major side effects of Aromasin is hypocalcemia and the subsequent loss of bone. Therefore, the patient needs to have periodic blood work done, have bone density tests done, and follow a diet that will supply needed calcium that is being pulled from the bone tissue.
A client with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this client's plan of care? Teach the client to perform all aspects of basic care independently. Situate the client in a shared room with other clients receiving brachytherapy. Assign male nurses to the client's care whenever possible. Limit the time that visitors spend at the client's bedside.
Limit the time that visitors spend at the client's bedside. Explanation: To limit radiation exposure, visitors should generally not spend more than 30 minutes with the client. Pregnant nurses or visitors should not be near the client, but there is no reason to limit care to nurses who are male. All necessary care should be provided to the client and a single room should be used.
During a routine mammogram, a client asks the nurse whether breast cancer causes the most deaths. Which type of cancer is the leading cause of death in the United States? Prostate Breast Lung Colorectal
Lung Explanation: Lung cancer is the leading cause of cancer-related deaths in the United States, followed by prostate cancer in men and breast cancer in women. Colorectal cancer is the third-leading cause of cancer-related deaths in the United States. Cancer is a common health problem worldwide.
Which is a growth-based classification of tumors? Malignancy Carcinoma Sarcoma Leukemia
Malignancy Explanation: Tumors classified on the basis of growth are described as benign or malignant. Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias.
According to the tumor-node-metastasis (TNM) classification system, T0 means there is No regional lymph node metastasis No distant metastasis Distant metastasis No evidence of primary tumor
No evidence of primary tumor Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.
A woman with a family history of breast cancer received a positive result on a breast tumor marking test and is requesting a bilateral mastectomy. This surgery is an example of which type of oncologic surgery? Salvage surgery Reconstructive surgery Palliative surgery Prophylactic surgery
Prophylactic surgery Explanation: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.
The nurse is describing some of the major characteristics of cancer to a client who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. Cell location Ability to spread Ability to cause death Cell size Rate of growth
Rate of growth Ability to cause death Ability to spread Explanation: Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Both benign and malignant cells can occur anywhere in the body.
After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority? Imbalanced nutrition: Less than body requirements Anxiety Risk for injury Risk for infection
Risk for infection Explanation: Risk for infection takes highest priority in clients with severe bone marrow depression because they have a decrease in the number of white blood cells, the cells that fight infection. Making clients aware that they are at risk for injuries can help prevent such injuries as falls. The nurse should institute the facility's falls prevention protocol and supply assistive devices, such as a walker, cane, or wheelchair, when needed. Imbalanced nutrition: Less than body requirements is also of concern but doesn't take priority over preventing infection. Anxiety is likely present in clients with severe bone marrow depression; however, anxiety doesn't take priority over preventing infection.
The nurse on a bone marrow transplant unit is caring for a client with cancer who has just begun hematopoietic stem cell transplantation (HSCT). What is the priority nursing diagnosis for this client? Risk for infection related to altered immunologic response Body image disturbance related to weight loss and anorexia Fatigue related to altered metabolic processes Altered nutrition: less than body requirements related to anorexia
Risk for infection related to altered immunologic response Explanation: Risk for infection related to altered immunologic response is the priority nursing diagnosis. HSCT involves intravenous infusion of autologous or allogeneic stem cells to promote red blood cell production in clients with compromised bone marrow or immune function, such as due to blood or bone marrow cancer. It carries an increased risk of sepsis and bleeding. The client's immunity is suppressed by the underlying condition necessitating the HSCT, the HSCT itself, and any cancer medications received. The client has a high risk for infection. Fatigue is appropriate but not the most critical nursing diagnosis. Altered nutrition and body image disturbance could be valid nursing diagnoses but would be of lower priority than risk for infection.
A young client has been diagnosed with cancer that has metastasized to the lungs. During client education, the client's mother asks about tumor staging and its relation to her child's condition. What stage would the nurse expect this client's tumor to be assigned? Stage IV Stage III Stage 0 Stage I
Stage IV Explanation: The TNM classification developed by the American Joint Committee on Cancer groups tumors together in a set of stages that include tumor size, evidence of metastasis, and lymph node involvement. In Stage IV, cancer has invaded or metastasized to other organs of the body. In Stages I, II, and III higher numbers indicate that the tumor is of greater size and/or the spread of cancer is to nearby lymph nodes and/or organs near the primary tumor. In stage 0 the cancer is in situ, which means the malignant cells are confined to the layer of cells in which they began, with no signs of metastasis
A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. The second and third drugs increase the effectiveness of the first drug. The three drugs can be given at lower doses.
The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Explanation: Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.
A client with a recent history of GI disturbance has been scheduled for a barium study. The physician ordered this particular test for this client because it will: show movement of the GI tract. show tumor "hot spots" in the GI tract. provide a three-dimensional cross-sectional view. remove a tissue sample from the GI tract.
show movement of the GI tract. Explanation: A barium study is an example of fluoroscopy, which is used to show continuous x-ray images on a monitor, allowing the movement of a body structure to be viewed. Fluoroscopy does not involve the biopsy of tissue samples. Nuclear imaging, not a barium study, uses IV tracers to reveal tumor hot spots. CT scans provide three-dimensional cross-sectional views of tissues to determine tumor density, shape, size, volume, and location as well as highlighting blood vessels that feed the tumor
A client has been diagnosed with a neoplasm and is seeking further information and possible treatment. The primary care physician described the neoplasm as "insidious." What does the word "insidious" mean? terminal aggressive life-threatening slow-growing
slow-growing Explanation: Cancer is insidious (slow growing).
A client being treated for breast cancer reports pain as being 7 on a scale from 0 to 10. Which type of pain indicates to the nurse that the client is experiencing lymph obstruction from the disease? Dull, aching, tightness Burning, sharp, tingling Distention, crampy Sharp, throbbing
Dull, aching, tightness Explanation: Cancer can cause all types of pain. The pain associated with breast cancer due to lymphatic or venous obstruction can be described as dull, aching, and tight. Sharp, throbbing pain is caused by ischemia. Distention and cramping is associated with organ infiltration. Burning, sharp, and tingling pain is caused by nerve compression and infiltration.
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs."
"Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.
The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? "I will eat clear liquids for the next 24 hours." "I will use birth control measures until after all treatment is completed." "Hair loss may not occur until after the second round of therapy." "I can continue taking my vitamins and herbs because they make me feel better."
"I can continue taking my vitamins and herbs because they make me feel better." Explanation: Herbal products are not regulated by the U.S. Food and Drug Administration (FDA);although some can decrease the risk of cancer, others can have serious side effects and liver toxicity. Use of vitamins and herbals should be reviewed with the oncologist. Use of clear liquids is recommended for the client experiencing nausea and vomiting. Because hair follicles are sensitive to chemotherapy drugs, it is likely for alopecia to occur especially with consecutive treatments. Chemotherapy includes cytotoxic drugs that are harmful to rapid dividing cells such as cell development in the fetus. To prevent damage to the fetus, birth control is recommended during treatment.
While on spring break, a 22-year-old client was taken to the hospital for heat stroke and alcohol poisoning. The client is worried and states that a biopsy was taken and showed "some kind of benign condition." Which response by the nurse would be best? "You have every right to be upset; a benign condition means you may have cancerous cells. Let me call your health care provider to talk to you." "I understand that you are worried. Benign conditions are noncancerous, but let's look at your chart to see your results." "Are you sure a biopsy was done? Your admitting diagnosis would not prompt that kind of procedure." "Do not worry; if something was wrong, your primary health care provider would have told you and started treatment."
"I understand that you are worried. Benign conditions are noncancerous, but let's look at your chart to see your results." Explanation: As a therapeutic listener, it is important to acknowledge the client's feelings and try to provide a resolution. Benign conditions are defined as noncancerous, and any treatment ordered would have been known by nursing. There is no reason to doubt the client's word regarding the biopsy, and, in any case, the nurse can confirm that the biopsy was performed by reviewing the client's chart. The client's admitting diagnosis could have promoted this test. Heat stroke and alcohol poisoning could enhance the body's inability to regulate internal temperatures and increase skin damage. The primary care provider may not have had time yet to discuss the details of the finding or to have initiated any treatment necessary. Also, this response does not provide the explanation of what "benign" means.
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? "I'll wear protective clothing when outside." "I'm worried I'll expose my family members to radiation." "I'll wash my skin with mild soap and water only." "I'll not use my heating pad during my treatment."
"I'm worried I'll expose my family members to radiation." Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
A computed tomography (CT) scan has detected a "spot" on a patient's liver, and a subsequent liver biopsy has revealed cancer and been submitted for staging and grading. The patient has asked you about the purpose of staging, stating that her oncologist's explanation left her somewhat confused. How could you best respond to this patient's question? "Staging is the process that helps your care team determine your prognosis for recovery." "The purpose of staging is to determine the site where your cancer most likely originated." "Staging is the process of classifying a tumor according to the type of tissue it's made of." "Staging allows the care team to determine how large and extensive your tumor is."
"Staging allows the care team to determine how large and extensive your tumor is." Explanation: Staging determines the size of the tumor and the extent of disease. It is not primarily used to identify the site of origin or prognosis, although staging is a piece of data that contributes to these determinations. Grading, not staging, involves histological identification.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? No further treatment is indicated. Adjuvant therapy is likely. Repeat biopsy is needed before treatment begins. Palliative care is likely.
Adjuvant therapy is likely. Explanation: T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? No further treatment is indicated. Palliative care is likely. Repeat biopsy is needed before treatment begins. Adjuvant therapy is likely.
Adjuvant therapy is likely. Explanation: T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.
Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer? Biopsy of the axillary lymph nodes Careful grading of the tumor cells Serial bone marrow biopsies Gauging her response to radiation therapy
Biopsy of the axillary lymph nodes Explanation: The transport of tumor cells through the lymphatic circulation is the most common mechanism of metastasis. Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates with lymphatic circulation. Breast tumors frequently metastasize in this manner through axillary, clavicular, and thoracic lymph channels.
Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? Family history Blood studies Allergy history Drug history
Blood studies Explanation: Before the BMT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate the client's family, drug, or allergy history.
The nurse is providing education to a client with cancer radiation treatment options. The nurse determines that the client understands the teaching when the client states that which type of radiation aims to protect healthy tissue during the treatment? Teletherapy Brachytherapy Proton therapy External
Brachytherapy Explanation: In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body through the use of an implant. With this type of therapy, the farther the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean? No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Can't assess tumor or regional lymph nodes and no evidence of metastasis
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Explanation: Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.
The hospice nurse has just admitted a new client to the program. What principle guides hospice care? The care team prioritizes the client's physical needs and the family is responsible for the client's emotional needs. Care is focused on the client centrally and the family peripherally. Care addresses the needs of the client as well as the needs of the family. The focus of all aspects of care is solely on the client.
Care addresses the needs of the client as well as the needs of the family. Explanation: The focus of hospice care is on the family as well as the client. The family is not solely responsible for the client's emotional well-being.
The nurse is caring for a 5-year-old client who has just received stem cell transplantation as treatment for his leukemia. What post-procedural intervention should the nurse perform? Closely monitor client for at least three months Closely monitor client for at least three days Closely monitor client for at least four weeks Closely monitor client for at least five months
Closely monitor client for at least three months Explanation: After stem cell transplantation, the nurse closely monitors the client for at least three months because complications related to the transplant are still possible and infections are very common.
A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation? Closely monitor the client for at least 3 days. Closely monitor the client for at least 3 months. Closely monitor the client for at least 4 weeks. Closely monitor the client for at least 5 months.
Closely monitor the client for at least 3 months. Explanation: After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common.
A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation? Closely monitor the client for at least 3 months. Closely monitor the client for at least 3 days. Closely monitor the client for at least 4 weeks. Closely monitor the client for at least 5 months.
Closely monitor the client for at least 3 months. Explanation: After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common.
Which of the following is a term used to describe a soft tissue injury produced by a blunt force? Strain Hematoma Contusion Sprain
Contusion Explanation: A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.
The drug interleukin-2 is an example of which type of biologic response modifier? Antimetabolites Cytokine Monoclonal antibodies Retinoids
Cytokine Explanation: Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.
The drug interleukin-2 is an example of which type of biologic response modifier? Retinoids Antimetabolites Cytokine Monoclonal antibodies
Cytokine Explanation: Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.
Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression? Increased white blood cells and c-reactive protein (CRP) Decreased sodium levels and decreased potassium levels Increased creatinine and blood urea nitrogen (BUN) Decreased platelets and red blood cells
Decreased platelets and red blood cells Explanation: Most chemotherapeutic agents cause myelosuppression (depression of bone marrow function), resulting in decreased production of blood cells. Myelosuppression decreases the number of WBCs (leukopenia), red blood cells (RBCs) (anemia), and platelets (thrombocytopenia), and increases the risk of infection and bleeding. It does not typically affect electrolytes, creatinine, BUN, and CRP levels.
A client who is receiving chemotherapy for esophageal cancer complains of "feeling sick to my stomach all the time." What is the best suggestion the nurse can make to help alleviate this client's nausea? Consume warm or hot foods. Consume more salty foods. Drink more soft drinks. Eat low-fat foods.
Eat low-fat foods. Explanation: Side effects of cancer and cancer therapies can devastate the client's ability to eat, which may change daily or as often as with each meal. Clients with nausea fare better with low-fat foods and "dry" meals (taking liquids between meals). Clients who are nauseated are better able to tolerate cold foods and beverages. Clients should limit soft drinks, which are high in empty calories. Salty items may aggravate mouth sores.
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? Take measures to acidify the urine and prevent uric acid crystallization. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis. Encourage fluid intake to dilute the urine.
Encourage fluid intake to dilute the urine. Explanation: The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage.
Which general nursing measure is used for a client with a fracture reduction? Assist with intake of immune-enhancing tube feeding formulas Promote intake of omega-3 fatty acids Examine the abdomen for enlarged liver or spleen Encourage participation in ADLs
Encourage participation in ADLs Explanation: General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation in ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. The nurse does not need to examine the abdomen for enlarged liver or spleen because fracture reduction treatment does not affect these organs. It is unlikely that a client with a fracture reduction will be prescribed immune-enhancing tube feeding formulas.
A patient with cancer who developed neutropenia several days ago has consequently been placed in a single-bed room that has positive pressure. His daughter has just come to visit her father after arriving from her home in another state and has asked you for his room number. You notice that the daughter has reddened eyes, sniffles, and a dry cough. What instruction should you provide to the daughter? "It's very important that you wash your hands thoroughly before you enter your father's room and as soon as you come out." "Your father is under neutropenic precautions right now so you're not allowed to visit him." "Your father is extremely vulnerable to infections right now, so I'm going to ask you to make sure you wear a gown when you go into his room." "Even though it might be difficult, it's best for your father's health if you get well before visiting him in person, since he's so vulnerable right now."
Even though it might be difficult, it's best for your father's health if you get well before visiting him in person, since he's so vulnerable right now." Explanation: Patients who are neutropenic need to be protected from exposure to infection. This means that visitors who are ill should not enter the patient's room. This should be explained clearly, but empathically, by the nurse. Handwashing and wearing a gown are not sufficient measures to protect a neutropenic patient. A visitor is unlikely to understand the term "neutropenic precautions."
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient? Wear a lead apron when providing direct patient care. Alert family members that they should restrict their visiting to 5 minutes at any one time. Maintain as much distance as possible from the patient while in the room. Explain to the patient that she will continue to emit radiation while the implant is in place.
Explain to the patient that she will continue to emit radiation while the implant is in place. Explanation: When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source.
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication? Extravasation Thrombosis Flare Erythema
Extravasation Explanation: The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? Time, distance, and shielding Inspect the skin frequently. Avoid showering or washing over skin markings. The use of disposable utensils and wash cloths
Inspect the skin frequently. Explanation: Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.
A nurse is performing a shift assessment on an elderly client who is recovering after surgery for a hip fracture. The client reports chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the client is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this client is likely demonstrating symptoms of what complication? Avascular necrosis of bone Compartment syndrome Fat embolism syndrome Complex regional pain syndrome
Fat embolism syndrome Explanation: Fat embolism syndrome occurs most frequently in young adults and elderly clients who experience fractures of the proximal femur (i.e., hip fracture). Presenting features of fat embolism syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick, white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies. This does not cause coughing. Complex regional pain syndrome does not have cardiopulmonary involvement.
A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client? Grieving Fear Knowledge Deficit Sexual Dysfunction
Fear Explanation: Fear of the unknown is probably the major concern for this client. This includes fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual Dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Grieving would not be a likely response at this time.
Which term refers to a break in the continuity of a bone? Subluxation Fracture Malunion Dislocation
Fracture Explanation: A fracture is a break in the continuity of the bone. A malunion occurs when a fractured bone heals in a misaligned position. Dislocation is a separation of joint surfaces. A subluxation is a partial separation or dislocation of joint surfaces.
The nurse is admitting an oncology client to the unit prior to surgery. The nurse reads in the electronic health record that the client has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem? Cardiac tamponade Impaired wound healing Tumor lysis syndrome Cognitive deficits
Impaired wound healing Explanation: Combining other treatment methods, such as radiation and chemotherapy, with surgery contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis. Cardiac tamponade, cognitive effects, and tumor lysis syndrome are less commonly associated with combination therapy.
An elderly client has been diagnosed with metastatic cancer and has a poor prognosis of survival. The family asks the nurse for advice on whether to tell the client of the diagnosis or to keep it quiet. Which is the best response from the nurse? "This is a private concern that should include the physician, not me." "The shock of learning the diagnosis may be too much stress for an elderly person." "I wouldn't tell, if I were you." "In my experience, clients who know are more likely to be involved with their plan of care."
In my experience, clients who know are more likely to be involved with their plan of care." Explanation: Sharing known facts that can enhance client care is advocating for the client and family. Clients do have the right to know their diagnosis so informed decisions can be made. Comments of not telling or saying it would be too much stress on the client are a reflection of personal opinion of the nurse, and opinions should be avoided. Stating the diagnosis is a private concern and did not involve the nurse may leave the family feeling as if the nurse is cold and uncaring.
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? Time, distance, and shielding Inspect the skin frequently. The use of disposable utensils and wash cloths Avoid showering or washing over skin markings.
Inspect the skin frequently. Explanation: Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.
A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse? "It will allow time for the repair of healthy tissue." "It is not really understood why you have to go for 6 weeks of treatment." "It will decrease the incidence of leukopenia and thrombocytopenia." "It allows time for you to cope with the treatment."
It will allow time for the repair of healthy tissue." Explanation: In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death.
A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Keeping a pillow between the client's legs at all times Turning the client from side to side every 2 hours Maintaining the client in semi-Fowler's position
Keeping a pillow between the client's legs at all times Explanation: After open reduction with internal fixation, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.
A decrease in circulating white blood cells (WBCs) is referred to as Thrombocytopenia Neutropenia Leukopenia Granulocytopenia
Leukopenia Explanation: A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low absolute neutrophil count.
Which type of surgery is used in an attempt to relieve complications of cancer? Palliative Prophylactic Salvage Reconstructive
Palliative Explanation: Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
The nurse is caring for a client who has just been told that stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the client the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? Salvage Prophylactic Palliative Reconstructive
Palliative Explanation: When cure is not possible, the goals of treatment are to make the client as comfortable as possible and to promote quality of life as defined by the client and family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration.
A nurse is planning the care of an older adult client who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage what actions? Select all that apply. Regular bone density testing A high-calcium diet Use of corticosteroids as prescribed Weight-bearing exercise Use of falls prevention precautions
Regular bone density testing A high-calcium diet Use of falls prevention precautions Weight-bearing exercise Explanation: Health promotion measures after an older adult's hip fracture include weight-bearing exercise, promotion of a healthy diet, falls prevention, and bone density testing. Corticosteroids have the potential to reduce bone density and increase the risk for fractures.
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? Causes generalized symptoms Undifferentiated cells Slow rate of growth Ability to invade other tissues
Slow rate of growth Explanation: Benign tumors have a slow rate of growth and well-differentiated cells. Benign tumors do not invade surrounding tissue and do not cause generalized symptoms unless the location of the tumor interferes with the functioning of vital organs.
The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? Monthly testicular exams Annual colonoscopies Smoking cessation Monthly self-breast exams
Smoking cessation Explanation: The leading causes of cancer death, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women. Smoking cessation is the health promotion initiative directly related to lung cancer.
A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms? Neutropenia Stomatitis Extravasation Nadir
Stomatitis Explanation: The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to 10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.
While a patient is receiving IV doxorubicin hydrochloride, the nurse observes that there is swelling and pain at the IV site. The nurse should: Continue to administer but decrease the rate of infusion. Apply a warm compress to the site. Notify the patient's health care provider. Stop the administration of the drug immediately.
Stop the administration of the drug immediately. Explanation: Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patient's health care provider. Ice can be applied to the site once the drug therapy has stopped.
The nursing instructor is discussing the difference between normal cells and cancer cells with the pre-nursing class in pathophysiology. What would the instructor cite as a characteristic of a cancer cell? The cell membrane of malignant cells contains proteins called tumor-specific antigens. Chromosomes are commonly found to be strong. Nuclei of cancer cells are large and regularly shaped. Malignant cells contain more fibronectin.
The cell membrane of malignant cells contains proteins called tumor-specific antigens. Explanation: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? The hair will grow back within 2 months post therapy. Alopecia related to chemotherapy is relatively uncommon. The hair will grow back the same as it was before treatment. The client should consider getting a wig or cap prior to beginning treatment.
The client should consider getting a wig or cap prior to beginning treatment. Explanation: If hair loss is anticipated and causing the client anxiety, a wig, cap, or scarf should be purchased before therapy begins. Alopecia develops because chemotherapy affects the rapidly growing cells of the hair follicles. Hair usually begins to grow again within 4 to 6 months after therapy. Clients should know that new growth may have a slightly different color and texture.
The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective? "I will reduce smoking to after meals only." "I will limit alcoholic beverages to one a day." "I will eat spicy foods with a cool beverage." "I will brush my teeth after every meal."
The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective? "I will reduce smoking to after meals only." "I will limit alcoholic beverages to one a day." "I will eat spicy foods with a cool beverage." "I will brush my teeth after every meal."
Which statement is true about malignant tumors? They usually grow slowly. They gain access to the blood and lymphatic channels. They grow by expansion They demonstrate cells that are well differentiated
They gain access to the blood and lymphatic channels. Explanation: By gaining access to blood and lymphatic channels, a tumor can metastasize to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rates of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
The physician is attending to a client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? To analyze the lymph nodes involved To prevent the formation of new cancer cells To destroy marginal tissues To remove the tumor from the brain
To prevent the formation of new cancer cells Explanation: Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present; also, it can be used prophylactically to prevent spread. Biopsy is used to analyze lymph nodes or to destroy the surrounding tissues around the tumor
The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? Random, rapid growth of the tumor Cells colonizing to distant body parts Tumor pressure against normal tissues Emission of abnormal proteins
Tumor pressure against normal tissues Explanation: Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.
The nurse is caring for an adult client who has developed a mild oral yeast infection following chemotherapy. What actions should the nurse encourage the client to perform? Select all that apply. Scrub the tongue with a firm-bristled toothbrush. Use a lip lubricant. Rinse the mouth with normal saline. Eat spicy food to aid in eradicating the yeast. Use dental floss every 24 hours.
Use a lip lubricant. Use dental floss every 24 hours. Rinse the mouth with normal saline. Explanation: Stomatitis is an inflammation of the oral cavity. The client should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.
A client has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray showed carcinoma. The client reports feeling anxious and asks to smoke. Which statement by the nurse would be most therapeutic? "You are anxious about the surgery. Do you see smoking as helping?" "The doctor left orders for you not to smoke." "Smoking is OK right now, but after your surgery it is contraindicated." "Smoking is the reason you are here."
You are anxious about the surgery. Do you see smoking as helping?" Explanation: Stating, "You are anxious about the surgery. Do you see smoking as helping?" acknowledges the client's feelings and encourages the client to assess their previous behavior. Saying, "Smoking is the reason you are here," belittles the client. Citing the doctor's orders does not address the client's anxiety. Giving approval for smoking would be highly detrimental to this client. Smoking is the single most lethal chemical carcinogen and accounts for about 30% of all cancer-related deaths.
A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is "You will experience menopause now." "You will continue having your menses every month." "You will be unable to have children." "You will need to practice birth control measures."
You will need to practice birth control measures." Explanation: Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.
The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply. dietary substances environmental factors viruses gender age
dietary substances environmental factors viruses Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.
The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply. chemical agents defective genes hormone replacement therapy viruses dietary substances environmental factors
dietary substances environmental factors viruses chemical agents defective genes hormone replacement therapy Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy.
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? drinks one glass of wine at dinner each night works as a secretary at a medical radiation treatment center uses the treadmill for 30 minutes on 5 days each week eats red meat such as steaks or hamburgers every day
eats red meat such as steaks or hamburgers every day Explanation: Dietary substances such as nitrate-containing and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. Alcohol consumption recommendations include drink no more than one drink per day for women or two per day for men.
The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of graft-versus-host disease. metastasis. nadir. acute leukopenia.
graft-versus-host disease.
Cancer is the second leading cause of death in the United States, second only to heart disease. Half of all men and one third of all women will develop cancer during their lifetimes. Which types of cancer have the highest prevalence among both men and women? colon and skin skin and brain lung and colon lung and skin
lung and colon Explanation: Common cancers in men include prostate, lung, and colon. Breast, lung, and colon cancer most commonly affect women.
Which term is a growth-based classification of tumors? sarcoma carcinoma malignant leukemia
malignant Explanation: Tumors classified on the basis of growth are described as benign or malignant.
During a routine physical examination, a client confides that he is terrified of developing prostate cancer like his father. What are the warning signs of prostate cancer? Select all that apply. pain in the upper thighs blood in the urine continuous pain in the lower back weak and interrupted urine flow easy bruising
weak and interrupted urine flow continuous pain in the lower back pain in the upper thighs Explanation: Warning signs of prostate cancer may include weak and interrupted urine flow and continuous pain in lower back, pelvis, and/or upper thighs.