Saunders: Cancer & Gender Specific Cancer -- breast, ovarian, cervical, and prostate
The nurse is reviewing the record of a client who was admitted to the hospital with a diagnosis of ovarian cancer. A client has received an unsealed radioactive isotope for treatment of thyroid cancer. Which instruction is essential for the nurse to provide the client? - "Flush the toilet at least 3 times after use." - "Increase intake of fruits with a core, such as apples and pears." - "Avoid contact with pregnant women, infants, and children for 3 months." - "Use disposable eating utensils, plates, and cups for the next 6 months."
"Flush the toilet at least 3 times after use." Bodily fluids contain the radioactive material, so others should be shielded from possible exposure. Clients should at best have a dedicated toilet for use during the first 2 weeks and should also flush 3 times after use. Some radioactivity will be in the saliva for about the first week, so during this time fruits with cores that will become contaminated should be avoided. Disposable eating utensils should also be used during this period of time. Contact with pregnant women, infants, and children is avoided for the first week and then a distance of 3 feet (1 meter) or more should be maintained and exposure should be limited to 1 hour per day.
A client has been hospitalized for removal of a cervical radiation implant used to treat cancer. The implant is removed, and the nurse provides home care instructions to the client. Which statement made by the client indicates a need for further instruction? - "Cream may be used to relieve dryness or itching." - "Some vaginal bleeding is expected for 1 to 3 months." - "Sexual intercourse may be resumed after 7 to 10 days." - "Foul-smelling vaginal discharge is a sign of an infection."
"Foul-smelling vaginal discharge is a sign of an infection." Some foul-smelling vaginal discharge is expected and is not a sign of an infection in this client. As well, this type of discharge will occur for some time after removal of a cervical radiation implant. All other options are accurate discharge instructions.
A client calls the ambulatory care clinic and tells the nurse that she found an area that looks like the peel of an orange when performing breast self-examination (BSE) but found no other changes. What is the nurse's best response to this client? - "Good job performing your BSE. I am sure that is nothing to be concerned about." - "Make sure you tell the primary health care provider about your finding at the next regularly scheduled visit." - "I am glad you called to report this finding. Can you come to the clinic to see your primary health care provider tomorrow?" - "Do you have a thermometer? You need to take your temperature and call back if you have a fever over 101º F (38.3º C)."
"I am glad you called to report this finding. Can you come to the clinic to see your primary health care provider tomorrow?" Peau d'orange or orange peel appearance of the skin over the breast is associated with late breast cancer. Therefore, the nurse would arrange for the client to come to the clinic as soon as possible. Peau d'orange is not indicative of an infection.
The nurse has provided instructions to a client regarding testicular self-examination (TSE). Which client statement indicates the need for further teaching regarding TSE? - "I know to report any small lumps." - "I examine myself every 2 months." - "I examine myself after I take a warm shower." - "I feel a hard and cord-like thing in back and going up."
"I examine myself every 2 months." TSE should be performed every month. Small lumps or abnormalities should be reported. The spermatic cord finding (option 4) is normal. After a warm bath or shower, the scrotum is relaxed, making it easier to perform TSE.
The ambulatory care nurse is providing discharge instructions to a female client who underwent cryosurgery with laser therapy because of a positive Papanicolaou test. Which statement by the client indicates an understanding of the instructions? - "I should take sitz baths every 4 hours for the next week." - "I should expect the vaginal discharge to be clear and watery." - "Very strong pain medications will be needed to relieve any discomfort I may have." - "If I note any odor to the vaginal discharge, I should call the primary health care provider immediately."
"I should expect the vaginal discharge to be clear and watery." Vaginal discharge should be clear and watery after cryosurgery with laser therapy. The client should be told that the vaginal discharge may be odorous as a result of the sloughing of dead cell debris. This vaginal odor takes about 8 weeks to resolve. The client should be instructed to avoid any sitz baths or tub baths while the area is healing, which takes approximately 10 weeks. Pain is mild after this procedure, and very strong pain medication will not be needed.
A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication to treat breast cancer. When implementing the plan, the nurse should make which statement to the client? - "You can take aspirin as needed for headache." - "You can drink beverages containing alcohol in moderate amounts each evening." - "You need to consult with the primary health care provider (PHCP) before receiving immunizations." - "It is fine to receive a flu vaccine at the local health fair without PHCP approval because the flu is so contagious."
"You need to consult with the primary health care provider (PHCP) before receiving immunizations." Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the PHCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.
A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? - "You can take aspirin as needed for headache." - "You can drink beverages containing alcohol in moderate amounts each evening." - "You need to consult with the primary health care provider (PHCP) before receiving immunizations." - "It is fine to receive a flu vaccine at the local health fair without PHCP approval because the flu is so contagious."
"You need to consult with the primary health care provider (PHCP) before receiving immunizations." Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the PHCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.
A client who is receiving chemotherapy for breast cancer develops myelosuppression. Which instructions should the nurse include in the client's discharge teaching plan? Select all that apply. - Avoid contact sports. - Wash hands frequently. - Increase intake of fresh fruits and vegetables. - Avoid crowded places such as shopping malls. - Treat a sore throat with over-the-counter products. - Avoid people who have received live attenuated vaccines.
- Avoid contact sports. - Wash hands frequently. - Avoid crowded places such as shopping malls. - Avoid people who have received live attenuated vaccines. Effective measures should be used to protect the client from infection and bleeding. A variety of interventions are essential to keep the client who is receiving chemotherapy safe. Live attenuated vaccines can easily infect clients with myelosuppression, and crowded places usually have people who are sick and coughing and sneezing, which can easily cause illness in myelosuppressed clients. Contact sports can result in injury or bleeding, and hand washing is the mainstay of asepsis and protection from infection. The client with myelosuppression should not eat fresh fruits and vegetables because of the risk of contamination or infection. All foods should be thoroughly cooked. Option 5 is incorrect because many over-the-counter products contain acetaminophen or aspirin, which could potentially mask an elevated temperature. Additionally, aspirin is an antiplatelet and can cause bleeding. Clients receiving chemotherapy should not take any other medications without direction from the primary health care provider.
The community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster? Select all that apply. - Multiparity - Early menarche - Early menopause - Family history of breast cancer - High-dose radiation exposure to chest - Previous cancer of the breast, uterus, or ovaries
- Early menarche - Family history of breast cancer - High-dose radiation exposure to chest - Previous cancer of the breast, uterus, or ovaries Risk factors for breast cancer include nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries. In addition, specific inherited mutations in BReast CAncer (BRCA)1 and BRCA2 increase the risk of female breast cancer; these mutations are also associated with an increased risk for ovarian cancer.
The nurse should include which intervention in the care of a client who has undergone a vaginal hysterectomy for the treatment of cancer? Select all that apply. - Elevate the knee gatch on the bed. - Encourage ambulation as prescribed. - Remove antiembolism stockings twice daily. - Assist with range-of-motion (ROM) leg exercises. - Check placement of pneumatic compression boots.
- Encourage ambulation as prescribed. - Remove antiembolism stockings twice daily. - Assist with range-of-motion (ROM) leg exercises. - Check placement of pneumatic compression boots. The client is at risk for deep vein thrombosis (DVT) or thrombophlebitis after this surgery, as with any other major surgery. The nurse should avoid using the knee gatch in the bed because doing so inhibits venous return, thus placing the client at greater risk for DVT or thrombophlebitis. The nurse will implement measures that prevent DVT or thrombophlebitis; ROM exercises, ambulation, antiembolism stockings, and pneumatic compression boots are all helpful.
The community health nurse is preparing an educational class on ovarian cancer for a group of women. Which signs and symptoms should the nurse include in the presentation? Select all that apply. - Feeling hungry all the time - Having urinary urgency or frequency - Experiencing pelvic or abdominal swelling - Sense of feeling that something is "falling out" - Developing a macular-papular rash over the abdomen
- Having urinary urgency or frequency - Experiencing pelvic or abdominal swelling Signs and symptoms of ovarian cancer are often very subtle. Urinary urgency or frequency, abdominal or pelvic pain or swelling, vague gastrointestinal disturbances such as dyspepsia or gas, and unexplained weight loss are potential signs and symptoms and require further investigation. Hunger and a rash are not associated with this condition. A sense of something "falling out" may be reported by the client experiencing uterine prolapse.
The nurse is reviewing a plan of care for a client with cancer of the cervix who is undergoing treatment with a cesium (radiation) implant. Which nursing interventions are most appropriate for this client? Select all that apply. - Maintain the client on bed rest. - Place the client on a low-fiber diet. - Keep the head of the bed flat at all times. - Restrict visitors to visiting for 60 minutes per day. - Stand at the entrance of the room to communicate with the client when possible.
- Maintain the client on bed rest. - Place the client on a low-fiber diet. - Stand at the entrance of the room to communicate with the client when possible. During application of the cesium implant, the client is on bed rest. The client may be logrolled from side to side, and the head of the bed may be raised to 45 degrees. The client is given a low-fiber diet to prevent frequent bowel movements, which is a side effect of the radiation. To minimize radiation exposure, the nurse stands at the head of the bed or at the entrance to the room. Visitors are limited to 30 minutes per day in the radiation area.
The nurse is reviewing the laboratory test results for a client receiving chemotherapy. The nurse notes that the white blood cell count is extremely low and places the client on neutropenic precautions. Which interventions are components of these types of precautions? Select all that apply. - Allowing only fresh fruits in the client's room - Removing fresh-cut flowers from the client's room - Encouraging the client to eat any types of fresh vegetables - Instructing family members on the proper technique for hand washing - Instructing family members to wear a mask when entering the client's room
- Removing fresh-cut flowers from the client's room - Instructing family members on the proper technique for hand washing - Instructing family members to wear a mask when entering the client's room In the immunocompromised client, a low-bacteria diet is necessary. This includes avoiding the intake of fresh fruits and vegetables. Thorough cooking of all food also is required. Cut flowers and any standing water are removed from the room because both tend to harbor bacteria. Anyone who enters the client's room should perform strict and thorough hand washing and wear a mask.
A client with a medical diagnosis of breast cancer is undergoing chemotherapy. The client complains to the nurse about losing her hair and severe fatigue from the treatment. Which interventions should the nurse implement for this client? Select all that apply. - Review side effects of chemotherapy and treatment with the client. - Teach the client how to resolve specific concerns of her personal life. - Teach the client to pace activities with rest so as to maintain strength. - Offer information on available counseling services and support groups. - Tell the client about some other clients who have had breast cancer treatment. - Inquire how the cancer diagnosis and treatment affect the client's normal routine.
- Review side effects of chemotherapy and treatment with the client. - Teach the client to pace activities with rest so as to maintain strength. - Offer information on available counseling services and support groups. - Inquire how the cancer diagnosis and treatment affect the client's normal routine. It is not therapeutic nor is it the nurse's role to teach the client how to resolve specific concerns of her personal life. The nurse should determine how the cancer diagnosis and treatment are affecting the client's normal routine, and the client should be aware of potential side effects of treatment so as to cope with the events with medications or other measures. It is important for the nurse to inform clients about support groups available (e.g., Reach for Recovery) so the client does not feel isolated. Teaching clients to pace activities even when they feel well will conserve energy so they ultimately feel stronger and less fatigued. It is a breach of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA) laws for the nurse to discuss other clients and their medical problems.
The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which are risk factors for cervical cancer? Select all that apply. - Smoking - Multiple sex partners - Human papillomavirus infection - Annual gynecological examinations - First intercourse before 17 years of age
- Smoking - Multiple sex partners - Human papillomavirus infection - First intercourse before 17 years of age Risk factors for cervical cancer include human papillomavirus infection, active and passive cigarette smoking, and certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, and male partners with multiple sex partners). Screening via regular gynecological examinations and Papanicolaou (Pap) tests with treatment of precancerous abnormalities decreases the incidence and mortality of cervical cancer.
The nurse is caring for a client diagnosed with breast cancer receiving combination chemotherapy. Which nursing intervention is the most appropriate? - Give 2 agents from the same medication class. - Give 2 agents with like nadirs at the same time. - Test the client's knowledge about each agent's nadir. - Avoid giving agents with the same nadirs and toxicities at the same time.
Avoid giving agents with the same nadirs and toxicities at the same time. Each chemotherapeutic agent has a specific nadir. Chemotherapy agents are usually given in combinations (also called regimens or protocols). The goal of administering combination chemotherapy in cycles or specific sequences is to produce additive or synergistic therapeutic effects. Administering several medications with different mechanisms of action and different onsets of nadirs and toxicities enhances tumor cell destruction while minimizing medication resistance and overlapping toxicities.
The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse include in discharge instructions? - Avoid driving the car for a few days. - Restrict fluid intake to prevent incontinence. - Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. - Notify the primary health care provider if small blood clots are noticed during urination.
Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. The client who has undergone a prostatectomy should avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. Driving a car and sitting for long periods are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Small pieces of tissue or blood clots may be passed during urination for up to 2 weeks after surgery; this is an expected occurrence.
The nurse is caring for a client with leukemia who is receiving intravenous chemotherapy. The nurse reviews the laboratory results and notes that the white blood cell count is 2000 mm3 (2 × 109/L), the platelet count is 150,000 mm3 (150 × 109/L), the clotting time is 10 minutes, and the ammonia level is 20 mcg/dL (12 mcmol/L). Which nursing action would be appropriate? - Place the client on bleeding precautions. - Place the client on neutropenic precautions. - Remove the rectal thermometer from the client's room. - Instruct the dietary department to eliminate all proteins from the client's diet.
Place the client on neutropenic precautions. The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). When the white blood cell count drops, neutropenic precautions need to be implemented. This includes protective isolation techniques to protect the client from infection. Bleeding precautions need to be initiated when the platelet count drops below 90,000 to 100,000 mm3 (90 to 100 × 109/L) or per primary health care provider prescription or agency policy. The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal clotting time is 8 to 15 minutes, and the normal ammonia level is 10 to 80 mcg/dL (6 to 47 mcmol/L). Removing the rectal thermometer from the client's room would be done if bleeding precautions were initiated. There is no useful reason to eliminate all protein from the diet.
The clinic nurse prepares instructions for a client diagnosed with leukemia who developed stomatitis after the administration of a course of antineoplastic medications. The nurse should provide the client with which instruction? - Avoid foods and fluids for the next 12 to 24 hours. - Swab the mouth with lemon and glycerin 4 times a day. - Rinse the mouth with a diluted solution of baking soda or saline. - Brush the teeth with a stiff-bristled toothbrush, and use dental floss 3 times a day.
Rinse the mouth with a diluted solution of baking soda or saline. Stomatitis (ulceration in the mouth) can result from the administration of antineoplastic medications. The client should be instructed to examine the mouth daily and report any signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with a diluted solution of baking soda or saline. Food and fluid are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet that includes milkshakes and ice cream. Instruct the client to avoid spicy foods and foods with hard crusts or edges. Lemon and glycerin swabs may cause pain and further irritation. The client should avoid brushing the teeth, particularly with a stiff-bristled toothbrush, and flossing when stomatitis is severe.
The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy for treatment of breast cancer. The nurse should plan which measure to treat this complication? - Rinse the mouth with diluted baking soda or saline. - Use lemon and glycerin swabs liberally on painful oral lesions. - Brush the teeth and use non-waxed dental floss at least twice a day. - Place the client on NPO (nothing by mouth) status for 12 hours, and then resume liquids.
Rinse the mouth with diluted baking soda or saline. Stomatitis, or mouth ulcerations, occurs with the administration of many antineoplastic medications. The client's mouth should be examined daily for signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with baking soda or saline. Lemon and glycerin swabs may cause pain and further irritation. The client should avoid brushing the teeth and flossing when stomatitis is severe. Food and fluids are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet. Instruct the client to avoid spicy foods and foods with hard crusts or edges.
The nurse is preparing to care for a client with a diagnosis of metastatic cancer. The nurse notes documentation in the client's chart that the client is experiencing cachexia. Which should the nurse expect to note on assessment of the client? - Elevated blood pressure and ascites - Sunken eyes and a hollow cheek appearance - Periorbital edema and swelling around the ears - Generalized edema and the presence of weight gain
Sunken eyes and a hollow cheek appearance Cachexia accompanies chronic wasting diseases and conditions such as cancer, dehydration, and starvation. Assessment findings in a client with cachexia include sunken eyes; hollow cheeks; and an exhausted, defeated expression. Options 1, 3, and 4 are not characteristic of a cachectic appearance.
The nurse is counseling a woman about decreasing her risk for cervical cancer. Which statement by the client indicates a need for further counseling? - "I need to seek prompt treatment for vaginitis." - "Condoms are needed only if I do not trust a new partner." - "A partner who is uncircumcised will present an increased risk." - "I need to keep appointments for Pap tests at the frequency advised by my primary health care provider."
"Condoms are needed only if I do not trust a new partner." Condoms should be used for adequate protection, especially with new partners. Sexually transmitted infections (which could be acquired without condom use) increase the client's risk of cervical cancer. Uncircumcised partners may present an increased risk. The woman should adhere to guidelines for early detection of cervical cancer (by Pap test) and should seek prompt treatment of vaginitis and cervicitis if they occur.
The nurse is doing preoperative teaching with a client newly diagnosed with a stage I cervical cancer. Which statement by the client indicates that education was effective? - "I have carcinoma that is just in the cervix." - "My carcinoma has extended to the pelvis and the vagina." - "I have carcinoma that has extended beyond the cervix but has not extended to the pelvic wall." - "My carcinoma has extended beyond the true pelvis and has involved the bladder or rectal mucosa."
"I have carcinoma that is just in the cervix." Stage I carcinoma is strictly confined to the cervix. In stage II, the carcinoma has extended beyond the cervix but has not extended to the pelvic wall. Stage III carcinoma has extended to the pelvic wall at the lower third of the vagina, and stage IV carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum.
The nurse teaches skin care to a client receiving external radiation therapy. Which client statement indicates the need for further instruction? - "I will handle the area gently." - "I will wear loose-fitting clothing." - "I will avoid the use of deodorants." - "I will limit sun exposure to 1 hour daily."
"I will limit sun exposure to 1 hour daily." The client needs to be instructed to avoid exposure to the sun. Because of the risk of altered skin integrity, options 1, 2, and 3 are accurate measures in the care of a client receiving external radiation therapy.
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? - "I should avoid blowing my nose." - "I may need a platelet transfusion if my platelet count is too low." - "I'm going to take aspirin for my headache as soon as I get home." - "I will count the number of pads and tampons I use when menstruating."
"I'm going to take aspirin for my headache as soon as I get home." During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells mm3 (20.0 × 109/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 antiplatelet activity. Options 1, 2, and 4 are correct statements by the client to prevent and monitor bleeding.
The nurse has provided discharge instructions to a client who underwent a right mastectomy with axillary lymph node dissection. Which statement made by the client indicates a need for further instruction regarding home care measures? - "It is all right to use a straight razor to shave under my arms." - "I must be sure to use thick potholders when I am cooking." - "I must be sure not to have blood pressures taken or blood drawn from my right arm." - "I should inform all of my other health care providers that I have had this surgical procedure."
"It is all right to use a straight razor to shave under my arms." After mastectomy with axillary lymph node dissection, the client is at risk for arm edema and infection. The client should be instructed regarding home care measures to prevent these complications. The client should be told to avoid activities such as carrying heavy objects or having blood pressure measurements taken on the affected arm. The client also should be instructed in the techniques to avoid trauma to the affected arm, such as using an electric razor to shave under the arms, using gloves when working in the garden, and using or wearing thick potholders when cooking.
Which statement made by a client who will undergo cytoreductive (debulking) surgery for ovarian cancer indicates that teaching by the nurse was effective? - "The surgery will remove precancerous tissue." - "The surgery will help to reduce the size of the tumor." - "The surgery will cure the cancer by removing all gross and microscopic tumor cells." - "The surgery is focused at improving the appearance of the previously treated body part."
"The surgery will help to reduce the size of the tumor." Cytoreductive or debulking surgery may be used if a large tumor cannot be removed completely, as is often the case with late-stage ovarian cancer (e.g., the tumor is attached to a vital organ or has spread throughout the abdomen). When this occurs, as much tumor as possible is removed, and adjuvant chemotherapy or radiation may be prescribed. Therefore, the remaining options are incorrect purposes for cytoreductive surgery.
The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication to treat breast cancer. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? Select all that apply. - Stop the infusion. - Prepare to apply ice or heat to the site. - Notify the primary health care provider (PHCP). - Restart the IV at a distal part of the same vein. - Prepare to administer a prescribed antidote into the site. - Increase the flow rate of the solution to flush the skin and subcutaneous tissue.
- Stop the infusion. - Prepare to apply ice or heat to the site. - Notify the primary health care provider (PHCP). - Prepare to administer a prescribed antidote into the site. Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the IV administration of an antineoplastic medication, the infusion is stopped and the PHCP is notified. Ice or heat may be prescribed for application to the site and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein.
The nurse is caring for a client with prostate cancer who is being treated with a hormone therapy. What should the nurse monitor for in order to evaluate the effect of this treatment? - An increase in testosterone levels - An increase in prostaglandin levels - An increase the amount of circulating androgens - A decline in the amount of circulating androgens
A decline in the amount of circulating androgens Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating androgens because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms. The remaining options do not identify the goals of this form of treatment.
The clinic nurse has conducted a health screening clinic to identify clients who are at risk for cervical cancer. The nurse is reviewing the assessment findings in the records of the clients who attended the clinic. Which client is at lowest risk for developing this type of cancer? - A multiparity client - A single white client - A client with a history of chronic cervicitis - A client who had early, frequent intercourse with multiple sexual partners
A single white client Risk factors associated with cervical cancer include early, frequent intercourse with multiple sexual partners; multiparity; chronic cervicitis; and a history of genital herpes or human papilloma. Cervical cancer also occurs with higher frequency in African Americans. Regarding the options provided, the single white client is at lowest risk for the development of cervical cancer.
During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease? - Diarrhea - Hypermenorrhea - Abnormal bleeding - Abdominal distention
Abdominal distention Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
A cervical radiation implant is placed in a client who is undergoing treatment of cervical cancer. The nurse should initiate which activity prescription as the most appropriate for this client? - Bed rest - Out of bed ad lib - Out of bed in a chair only - Ambulation to the bathroom only
Bed rest The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.
A 27-year-old client is undergoing evaluation of lumps in her breasts. In determining whether the client could have fibrocystic breast disorder, the nurse should ask her whether the breast lumps seem to become more prominent or troublesome at which time? - After menses - Before menses - During menses - At any time, regardless of the menstrual cycle
Before menses The nurse assesses the client with fibrocystic breast disorder for worsening of symptoms (breast lumps, painful breasts, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormone changes. Therefore, the other options are incorrect.
The nurse is caring for a chemotherapy client with a low platelet aggregation level. Which likely caused this decreased platelet production? - Anemia - Thrombocytopenia - Bone marrow suppression - Low hemoglobin and hematocrit (H&H) counts
Bone marrow suppression Suppression of bone marrow function is a result of many chemotherapy medications leading to inhibition of platelet production. Because of bone marrow suppression, chemotherapy clients are at risk of bruising and bleeding, and these risks are increased by medications that inhibit platelet function, such as most conventional nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin is especially dangerous because it causes irreversible inhibition of platelet aggregation. The other options are incorrect.
A client is admitted to the nursing unit after undergoing radical prostatectomy for cancer. The nurse anticipates that which problem would be of most concern to the client in the immediate postoperative period? - Concern about the outcome of surgery - Continuous pain because of the effects of cancer - Appearance disturbance as a result of the presence of a suprapubic catheter - Concern about caring for self at home because of insufficient help after discharge
Concern about the outcome of surgery In the immediate postoperative period, the client who has had surgery for cancer may experience fear or concern related to the uncertain outcome of surgery. Postoperative pain is classified as acute, not continuous. The client may experience an alteration in appearance, but this is more likely to be related to the anticipated change in sexual function than the presence of the suprapubic catheter. The priority focus in the immediate postoperative period is not on concerns that apply to hospital discharge.
The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late sign or symptom of this oncological emergency? - Headache - Dysphagia - Constipation - Electrocardiographic changes
Electrocardiographic changes Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.
The nurse has admitted a client to the clinical nursing unit after undergoing a right mastectomy. The nurse should plan to place the right arm in which position? - Elevated on a pillow - Level with the right atrium - Dependent to the right atrium - Elevated above shoulder level
Elevated on a pillow The client's operative arm should be positioned so that it is elevated on a pillow and not exceeding shoulder elevation. This position promotes optimal drainage from the limb, without impairing the circulation to the arm. If the arm is positioned flat (option 2) or dependent (option 3), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery.
The nurse has admitted a client to the clinical nursing unit after undergoing a right mastectomy. The nurse should plan to place the right arm in which position? - Elevated on a pillow - Level with the right atrium - Dependent to the right atrium - Elevated above shoulder level
Elevated on a pillow The client's operative arm should be positioned so that it is elevated on a pillow and not exceeding shoulder elevation. This position promotes optimal drainage from the limb, without impairing the circulation to the arm. If the arm is positioned flat (option 2) or dependent (option 3), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery.
The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? - Placing cool compresses on the affected arm - Elevating the affected arm on a pillow above heart level - Avoiding arm exercises in the immediate postoperative period - Maintaining an intravenous site below the antecubital area on the affected side
Elevating the affected arm on a pillow above heart level Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.
For the client with stomatitis resulting from chemotherapy, the care plan should include which intervention? - Inspect the mouth every week for fungus. - Encourage foods with neutral or cool temperatures. - Give the client spicy foods to stimulate the sense of taste. - Perform frequent oral hygiene using a commercial alcohol-based mouthwash.
Encourage foods with neutral or cool temperatures. Stomatitis is inflammation of the oral cavity, and using commercial mouthwashes containing alcohol or encouraging spicy foods will cause pain. Foods are better tolerated by the client with stomatitis when the food is cool or of neutral temperature. It is important to monitor for oral fungal infections, but this assessment should be completed at least daily.
A woman has just been told by the primary health care provider that she has breast cancer. The woman responds, "Oh, no! Does this mean I'm going to die?" The nurse interprets the woman's initial reaction as which response? - Fear - Rage - Denial - Anxiety
Fear The woman's reaction is one of fear. The woman has verbalized the object of fear (dying), which makes anxiety incorrect. There is no evidence of rage or denial in the woman's statement.
The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? - Anemia - Decreased platelets - Increased uric acid level - Decreased leukocyte count
Increased uric acid level Hyperuricemia is especially common following treatment for leukemias and lymphomas, because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.
A community health nurse is providing an educational session on cancer of the cervix for women living in the community. The nurse informs the community residents that which is an early sign of this type of cancer? - Abdominal pain - Constant and profuse bleeding - Irregular vaginal bleeding or spotting - Dark and foul-smelling vaginal drainage
Irregular vaginal bleeding or spotting Early cancer of the cervix usually is asymptomatic. The 2 chief symptoms are leukorrhea (vaginal discharge) and irregular vaginal bleeding or spotting. The vaginal discharge increases gradually in amount and becomes watery and finally dark and foul-smelling because of necrosis and infection of the tumor mass. As the disease progresses, the bleeding may become constant and may increase in amount.
The nurse is providing care to a client who has undergone modified right mastectomy for the treatment of breast cancer. Which activity should the nurse incorporate into the plan of care? - Keep suction drains fully inflated to provide adequate suction. - Perform venipunctures and blood pressures on the operative side only. - Inform the client that drains will be removed on the second postoperative day. - Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow.
Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow. The client should have the head of the bed elevated at least 30 degrees with the affected arm elevated on a pillow. Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. Gentle suction must be maintained on the drain bulb to prevent fluid accumulation at the operative site. With short hospital stays, drainage tubes are usually removed about 1 to 3 weeks after hospital discharge when the client returns for an office visit. All staff must avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood.
The nurse is caring for a client with metastatic breast cancer. The client describes a new and sudden sharp pain in the back. Based on this assessment finding, which is the priority nursing intervention? - Document the findings. - Administer pain medication. - Place a heating pad on the client's back. - Notify the primary health care provider (PHCP).
Notify the primary health care provider (PHCP). Spinal cord compression should be suspected in a client with metastatic disease, particularly with sudden onset of new back pain. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression constitutes an oncological emergency, so the PHCP should be notified. Although the nurse would document this finding, this is not the priority action. The nurse would not administer pain medication or place a heating pad on the client unless the cause of the new pain has been determined. In addition, a prescription from the PHCP is needed for the use of a heating pad.
The client has undergone mastectomy. The nurse determines that the client is making the best adjustment to the loss of the breast if which behavior is observed? - Refusing to look at the wound - Reading the postoperative care booklet - Asking for pain medication when needed - Participating in the care of the surgical drain
Participating in the care of the surgical drain The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that are in place for a short time after discharge. Refusing to look at the wound indicates no adaptation to the loss. Reading the postoperative care booklet is useful but is not the best of the options presented here. Asking for pain medication is an action-oriented option, but it does not relate to acceptance of the loss of the breast.
The home care nurse visits a client who has just returned home from the hospital after a mastectomy with a suction drain in place. Which observed client behavior requires a need for further teaching? - Empties the drain to prevent infection - Elevates the arm when lying and sitting - Applies lotion to the area after the incision heals - Performs full range-of-motion exercises to the upper arm
Performs full range-of-motion exercises to the upper arm The client should be instructed to limit upper arm range-of-motion exercises to the level of the shoulder only. Once the suction drain has been removed, the client can begin full range-of-motion exercises to the upper arm as prescribed. The client should elevate the arm while sitting down or lying, and the client will be able to apply lotion to the incision once it has healed. The drain is emptied as needed.
The nurse should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which result was reported from the laboratory? - Clotting time 12 seconds - Platelet count 50,000 mm3 (50 × 109/L) - Ammonia level 28 mcg/dL (16.8 mcmol/L) - White blood cell (WBC) count 4500 mm3 (4.5 × 109/L)
Platelet count 50,000 mm3 (50 × 109/L) Platelets are the building blocks of blood clots. The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). Bleeding precautions should be instituted when the platelet count drops to a low level, as defined by agency policy. Bleeding precautions include avoiding all trauma, such as rectal temperatures or injections. The normal clotting time is 8 to 15 seconds. The normal ammonia value is 10 to 80 mcg/dL (6 to 47 mcmol/L). The normal WBC count is 5000 to 10,000 mm3 (5 to 10 × 109/L). When the WBC count drops, neutropenic precautions should be implemented.
The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse should prepare to implement which action based on this finding? - Remove the fresh flowers from the client's room. - Remove the rectal thermometer from the client's room. - Instruct family members to wear a mask when entering the client's room. - Call the dietary department to report that the client will be on a low-bacteria diet.
Remove the rectal thermometer from the client's room. When the client's platelet count is low, the client is at risk for bleeding. Options 1, 3, and 4 relate to the risk for infection. Rectal temperatures should not be taken on a client who is at risk for bleeding because the thermometer could cause an alteration in the delicate rectal membranes and lead to bleeding.
The home health care nurse is visiting a client who has undergone a mastectomy. The nurse determines that the client demonstrates greatest adjustment to the loss of the breast if which behavior is noted? - The client looks at the surgical site. - The client performs the prescribed arm exercises. - The client takes the pain medication as prescribed. - The client has read all of the postoperative materials provided by the hospital nurse.
The client looks at the surgical site. Of the options provided, the client behavior in the correct option demonstrates the greatest adaptation or adjustment (looking at the surgical site). This indicates that the client has acknowledged and is beginning to cope with the loss of the breast. Reading postoperative care booklets and performing prescribed exercises indicate an interest in self-care and are positive signs indicating adjustment. Taking pain medication is not related to adjustment to the loss of the breast.
The nurse in the primary health care provider's office is performing a postoperative assessment of a client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should provide which information to the client about her complaint? - These sensations are signs of a complication. - These sensations probably will be permanent. - These sensations dissipate over several months and usually resolve after 1 year. - It is nothing to worry about because most women who have this type of surgery experience this problem.
These sensations dissipate over several months and usually resolve after 1 year. Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow occurs in most women after mastectomy. It is a result of injury to the nerves that provide sensation to the skin in those areas. These sensations may be described as heaviness, pain, tingling, burning, or "pins and needles." These sensations dissipate over several months and usually resolve by 1 year after surgery. These sensations are not a sign of a complication and are not permanent. The nurse would not tell the client that a complaint is nothing to worry about because this is nontherapeutic and avoids the client's concern.
The community health nurse is preparing an educational session for a group of women and will be discussing the primary prevention strategies and treatment measures for breast cancer. What information should the nurse include in the educational session? - Older women are more likely to get mammograms. - Treatment decisions are based on a woman's overall health. - Women younger than age 65 are more likely to get breast cancer. - A woman's age is the main factor used to decide which screening methods to use.
Treatment decisions are based on a woman's overall health. Breast cancer occurs most often in women who are 65 years of age or older, and older women are less likely to have mammograms. Rather than using the woman's age to decide on screening and treatment measures, the woman's overall health is used to make these determinations, since health status has a greater influence on tolerance to treatment.
The nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. The nurse should teach the client to put the pillow in which location for self-examination of the right breast? - Under the left scapula - Under the left shoulder - Under the right shoulder - Under the small of the back
Under the right shoulder The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder and vice versa. Therefore, options 1, 2, and 4 are incorrect.
The nurse is providing discharge instructions to a client who has undergone treatment of cervical cancer with a radiation (cesium) implant. Which instruction should the nurse provide to the client? - Avoid douching for at least 1 year. - Use a vaginal dilator 3 times a week. - Sexual activity can be resumed in about 2 months. - Bed rest is recommended for at least 1 week after discharge.
Use a vaginal dilator 3 times a week. Radiation causes scarring and fibrosis of the vagina, with a decrease in normal vaginal secretions. The client is instructed to use a vaginal dilator to prevent vaginal narrowing and stenosis. A vaginal discharge often occurs, and the woman may need to douche twice daily for as long as the discharge and odor persist. Sexual activity after internal radiation treatment can be resumed in about 3 weeks. Bed rest is not required.
A client receiving chemotherapy is experiencing mucositis. The nurse should advise the client to use which item as the best substance to rinse the mouth? - Alcohol-based mouthwash - Hydrogen peroxide mixture - Lemon-flavored mouthwash - Weak salt and bicarbonate mouth rinse
Weak salt and bicarbonate mouth rinse An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of the presence of severe plaque, it should be a weak solution, because hydrogen peroxide dries the mucous membranes.
