Cancer Quiz
A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? A) Pruritus (itching) B) Nausea and vomiting C) Altered glucose metabolism D) Confusion
. ANS: B Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these clients. Confusion, alterations in glucose metabolism, and pruritus are less common adverse effects.
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? A) Smoked salmon and green beans B) Pork chops and fried green tomatoes C) Baked apricot chicken and steamed broccoli D) Liver, onions, and steamed peas
ANS: C 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.
A client has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test? A) Glucose tolerance test B) ERCP C) Pancreatic biopsy D) Abdominal ultrasonography
ANS: A A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for making decisions about surgical resection of the pancreas. This specific clinical information is not provided by ERCP, biopsy, or ultrasound.
A nurse is planning the care of a client who has been diagnosed with essential thrombocythemia (ET). What nursing diagnosis should the nurse prioritize when choosing interventions? A) Risk for Ineffective Tissue Perfusion B) Risk for Imbalanced Fluid Volume C) Risk for Ineffective Breathing Pattern D) Risk for Ineffective Thermoregulation
ANS: A Clients with ET are at risk for hypercoagulation and consequent ineffective tissue perfusion. Fluid volume, breathing, and thermoregulation are not normally affected.
What nursing action best demonstrates primary cancer prevention? A) Encouraging yearly Pap tests B) Teaching testicular self-examination C) Teaching clients to wear sunscreen D) Facilitating screening mammograms
ANS: C Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.
A clinic nurse is working with a client who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the client's disease? A) Document the color of the client's palms and face during each visit. B) Follow the client's erythrocyte sedimentation rate over time. C) Document the client's response to erythropoietin injections. D) Follow the trends of the client's hematocrit.
ANS: D The course of polycythemia vera can be best ascertained by monitoring the client's hematocrit, which should remain below 45%. Erythropoietin injections would exacerbate the condition. Skin tone should be observed, but is a subjective assessment finding. The client's ESR is not relevant to the course of the disease.
An oncology nurse is providing health education for a client who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? A) The different leukemias all involve unregulated proliferation of white blood cells. B) The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function. C) The different leukemias all result in a decrease in the production of white blood cells. D) The different leukemias all involve the development of cancer in the lymphatic system.
ANS:A Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia. The leukemias are not characterized by their involvement with the lymphatic system.
A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite? A) High levels of alcohol consumption B) History of bowel obstruction C) History of diverticulitis D) Longstanding psychosocial stress
ANS:A Risk factors include high alcohol intake; cigarette smoking; and high-fact, high-protein, low-fiber diet. Diverticulitis, obstruction, and stress are not noted as risk factors for colorectal cancer.
While a client is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action? A) Stopping the administration of the drug immediately B) Notifying the client's physician C) Continuing the infusion but decreasing the rate D) Applying a warm compress to the infusion site
ANS: A 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 client's physician. Ice can be applied to the site once the drug therapy has stopped.
An adult woman's mother died of left breast cancer. If the client and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? A) More aggressive chemotherapy B) Left mastectomy C) Radiation therapy D) Bilateral mastectomy
ANS: D Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the client's unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.
The nurse is caring for a client who has just been told that her ovarian cancer is terminal and that no curative options remain. What would be the priority nursing care for this client at this time? A) Provide emotional support to the client and her family B) Implement distraction and relaxation techniques C) Offer to inform the client's family of this diagnosis D) Teach the client about the importance of maintaining a positive attitude
ANS: A Emotional support is an integral part of nursing care at this point in the disease progression. It is not normally appropriate for the nurse to inform the family of the client's diagnosis. It may be inappropriate and simplistic to focus on distraction, relaxation, and positive thinking.
An oncology nurse is caring for a client with multiple myeloma who is experiencing bone destruction. When reviewing the client's most recent blood tests, the nurse should anticipate what imbalance? A) Hypercalcemia B) Hyperproteinemia C) Elevated serum viscosity D) Elevated RBC count
ANS: A Hypercalcemia may result when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.
A client with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the client? A) Chew with care to avoid inadvertently biting the tongue. B) Use the oral anesthetic 1 hour prior to meal time. C) Brush teeth before and after eating. D) Swallow slowly and deliberately.
ANS: A If oral anesthetics are used, the client must be warned to chew with extreme care to avoid inadvertently biting the tongue or buccal mucosa. An oral anesthetic would be metabolized by the time the client eats if it is used 1 hour prior to meals. There is no specific need to warn the client about brushing teeth or swallowing slowly because an oral anesthetic has been used.
A nurse is caring for a client who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among clients with leukemia? A) Monitoring for infection B) Monitoring nutritional status C) Monitor electrolyte levels D) Monitoring liver function
ANS: A In clients with acute leukemia, death typically occurs from infection or bleeding. Compromised nutrition, electrolyte imbalances, and impaired liver function are all plausible, but none are among the most common causes of death in this client population.
A client who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. During the nurse's admission assessment, the nurse observes that the client is distracted and tense. What is the nurse's best action? A) Acknowledge the fear the client is likely experiencing B) Describe the support groups that exist in the community C) Assess the client's stress management skills D) Document a nursing diagnosis of ineffective coping
ANS: A In the breast cancer diagnostic phase, it is appropriate to acknowledge the client's feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills may be necessary, but the nurse should begin by acknowledging the client's feelings. Fear is not necessarily indicative of ineffective coping.
A client has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment? A) Lumpectomy and radiation B) Partial mastectomy and radiation C) Partial mastectomy and chemotherapy D) Total mastectomy and chemotherapy
ANS: A Treatment for breast cancer depends on the disease stage and type, the client's age and menopausal status, and the disfiguring effects of the surgery. For this client, lumpectomy is the most likely option because the nodule is well defined. The client usually undergoes radiation therapy afterward. Because a lumpectomy is possible, mastectomy would not be the treatment of choice.
The nurse is caring for a client who has just been told that her 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? A) Palliative B) Reconstructive C) Salvage D) Prophylactic
ANS: A 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 their family. 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. 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. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.
A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A) Liver function tests (LFTs) B) Complete blood count (CBC) C) Platelet count D) Blood urea nitrogen and creatinine
ANS: A Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.
A client with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the client should be informed that this procedure will involve the removal of which of the following? Select all that apply. A) Gallbladder B) Part of the stomach C) Duodenum D) Part of the common bile duct E) Part of the rectum
ANS: A, B, C, D A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer of the head of the pancreas. This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. The rectum is not affected.
A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply. A) Promotion of HPV immunization B) Encouraging young women to delay first intercourse C) Smoking cessation D) Vitamin D and calcium supplementation E) Using safer sex practices
ANS: A, B, C, E Preventive measures relevant to cervical cancer include regular pelvic examinations and Pap tests for all women, especially older women past childbearing age. Preventive counseling should encourage delaying first intercourse, avoiding HPV infection, participating in safer sex only, smoking cessation, and receiving HPV immunization. Calcium and vitamin D supplementation are not relevant.
An oncology nurse recognizes a client's risk for fluid imbalance while the client is undergoing treatment for leukemia. What related assessments should the nurse include in the client's plan of care? Select all that apply. A) Monitoring the client's electrolyte levels B) Monitoring the client's hepatic function C) Measuring the client's weight on a daily basis D) Measuring and recording the client's intake and output E) Auscultating the client's lungs frequently
ANS: A, C, D, E Assessments that relate to fluid balance include monitoring the client's electrolytes, auscultating the client's chest for adventitious sounds, weighing the client daily, and closely monitoring intake and output. Liver function is not directly relevant to the client's fluid status in most cases.
A client with a diagnosis of colon cancer is 2 days postoperative following bowel resection and anastomosis. The nurse has planned the client's care in the knowledge of potential complications. What assessment should the nurse prioritize? A) Close monitoring of temperature B) Frequent abdominal auscultation C) Assessment of hemoglobin, hematocrit, and red blood cell levels D) Palpation of peripheral pulses and leg girth
ANS: B After bowel surgery, it is important to frequently assess the abdomen, including bowel sounds and abdominal girth, to detect bowel obstruction. The resumption of bowel motility is a priority over each of the other listed assessments, even though each should be performed by the nurse. Obstruction can develop more quickly than infection in most cases.
A nurse caring for a client with colorectal cancer is preparing the client for upcoming surgery. The nurse administers cephalexin to the client and explains what rationale? A) To treat any undiagnosed infections B) To reduce intestinal bacteria levels C) To reduce bowel motility D) To reduce abdominal distention postoperatively
ANS: B Antibiotics such a kanamycin (Kantrex), neomycin (Mycifradin), and cephalexin (Keflex) are given orally the day before surgery to reduce intestinal bacterial. Preoperative antibiotics are not given to treat undiagnosed infections, reduce motility, or prevent abdominal distention.
A 42-year-old client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this client's lump is cancerous? A) Eversion of the right nipple and mobile mass B) A nonmobile mass with irregular edges C) A mobile mass that is soft and easily delineated D) Nonpalpable right axillary lymph nodes
ANS: B Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.
client with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the client's health history. What clinical manifestation would the nurse expect to assess? A) Fish-like vaginal odor B) Increased abdominal girth C) Fever and chills D) Lower abdominal pelvic pain
ANS: B Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a rise in the vaginal pH. Fever, chills, and abdominal pelvic pain are atypical.
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? A) Cognitive deficits B) Impaired wound healing C) Cardiac tamponade D) Tumor lysis syndrome
ANS: B 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.
A client was diagnosed with cancer several weeks ago and family members describe him as "utterly distraught." The client has fully withdrawn from social and family contact. What is the nurse's best action? A) Reassure the client and the family that these types of responses to cancer are common B) Refer the client to the appropriate mental health provider C) Educate the client about the mental health benefits of exercise D) Reassure the family that the client is grieving and will eventually come to terms with the diagnosis
ANS: B Emotional responses to cancer diagnosis are expected, but this client's response is atypical. The nurse should avoid false reassurance and exercise alone is unlikely to provide a solution. For these reasons, a referral is necessary.
A nurse is providing care for a client whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis? A) Encourage the client to conduct online research into colostomies. B) Engage the client in dialogue about the implications of having the colostomy. C) Emphasize the fact that the colostomy was needed to alleviate a much more serious health problem. D) Emphasize the fact that the colostomy is temporary measure and is not permanent.
ANS: B For many clients, being able to dialogue frankly about the effect of the ostomy with a nonjudgmental nurse is helpful. Emphasizing the benefits of the intervention is unlikely to improve the client's body image, since the benefits are likely already known. Online research is not likely to enhance the client's body image and some ostomies are permanent.
When teaching clients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A) Late childbearing B) Human papillomavirus (HPV) C) Postmenopausal bleeding D) Tobacco use
ANS: B HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding.
A 45-year-old woman comes into the health clinic for her annual checkup. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred over a few months. What assessment would be most appropriate for the nurse to make? A) Palpate the client's breasts for tenderness and assess for infection B) Palpate the area for a breast mass C) Assess the client's knowledge of breast cancer D) Assure the client that this is likely an age-related change
ANS: B It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the client to her primary provider. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance (peau d'orange), a classic sign of advanced breast cancer. The client's knowledge of breast cancer is relevant, but is not a time-dependent priority. This finding is not an age-related change. Assessment for signs of malignancy is a priority over infection, which is unlikely to cause these changes.
A client diagnosed with acute myelogenous leukemia has just been admitted to the oncology unit. When writing this client's care plan, what potential complication should the nurse address? A) Pancreatitis B) Hemorrhage C) Arteritis D) Liver dysfunction
ANS: B Pancreatitis, arteritis, and liver dysfunction are generally not complications of leukemia. However, the client faces a high risk of hemorrhage.
An oncology nurse educator is providing health education to a client who has been diagnosed with skin cancer. The client's wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite? A) Malignant cells possess greater mobility than normal body cells. B) Malignant cells contain proteins called tumor-associated antigens. C) Chromosomes contained in cancer cells are more durable and stable than those of normal cells. D) The nuclei of cancer cells are unusually large, but regularly shaped
ANS: B 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-associated antigens. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism), though they are not always mobile. Fragility of chromosomes is commonly found when cancer cells are analyzed.
A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary provider, the nurse should perform what action? A) Initiate measures to prevent venous thromboembolism (VTE). B) Check the client's most recent platelet level. C) Place the client on protective isolation. D) Ambulate the client to promote circulatory function.
ANS: B The client's signs are suggestive of thrombocytopenia, thus the nurse should check the client's most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.
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? A) Monthly self breast exams B) Smoking cessation C) Annual colonoscopies D) Monthly testicular exams
ANS: B 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, so smoking cessation is the health promotion initiative directly related to lung cancer.
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? A) Fatigue related to altered metabolic processes B) Altered nutrition: less than body requirements related to anorexia C) Risk for infection related to altered immunologic response D) Body image disturbance related to weight loss and anorexia
ANS: C A priority nursing diagnosis for this client is risk for infection related to altered immunologic response. Because the client's immunity is suppressed, he or she will be at a high risk for infection. The other listed nursing diagnoses are valid, but they are not as high a priority as is risk for infection.
A client's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this client's health problem? A) Adherence to a high-fiber diet will help the polyps resolve. B) The client should be assured that these are a normal, age-related physiologic change. C) The client's polyps constitute a risk factor for cancer. D) The presence of polyps is associated with an increased risk of bowel obstruction.
ANS: C Although most polyps do not develop into invasive neoplasms, they must be identified and followed closely. They are very common, but are not classified as a normal, age-related physiologic change. Diet will not help them resolve and they do not typically lead to obstructions.
An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The client denies any recent injuries. The nurse should recognize the need for this client to be assessed for what health problem? A) Hodgkin disease B) Non-Hodgkin lymphoma C) Multiple myeloma D) Acute thrombocythemia
ANS: C Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older clients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.
A client with a myelodysplastic syndrome is being treated on the medical unit. What assessment finding should prompt the nurse to contact the client's primary provider? A) The client is experiencing a frontal lobe headache. B) The client has an episode of urinary incontinence. C) The client has an oral temperature of 37.5C (99.5F). D) The client's SpO2 is 91% on room air.
ANS: C Because the client with MDS is at a high risk for infection, any early signs of infection must be reported promptly. The nurse should address each of the listed assessment findings, but none are as direct a threat to the client's immediate health as an infection.
A client on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in clients at risk for thrombocytopenia? A) Interrupted sleep pattern B) Hot flashes C) Epistaxis D) Increased weight
ANS: C Clients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. Clients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.
A client's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the client has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse's most appropriate response to this observation? A) Ensure that the client knows that he or she will be responsible for care after discharge. B) Reassure the client that many people are fearful after the creation of an ostomy. C) Acknowledge the client's reluctance and initiate discussion of the factors underlying it. D) Arrange for the client to be seen by a social worker or spiritual advisor.
ANS: C If the client is reluctant to participate in ostomy care, the nurse should attempt to dialogue about this with the client and explore the factors that underlie it. It is presumptive to assume that the client's behavior is motivated by fear. Assessment must precede referrals and emphasizing the client's responsibilities may or may not motivate the client.
A 30-year-old client has come to the clinic for her yearly examination. The client asks the nurse about ovarian cancer. What should the nurse state when describing risk factors for ovarian cancer? A) "Use of oral contraceptives increases the risk of ovarian cancer." B) "Most cases of ovarian cancer are attributed to tobacco use." C) "Most cases of ovarian cancer are considered to be random, with no obvious causation." D) "The majority of women who get ovarian cancer have a family history of the disease."
ANS: C Most cases of ovarian cancer are random, with only 5% to 10% of ovarian cancers having a familial connection. Contraceptives and tobacco have not been identified as major risk factors.
An oncology client has just returned from the postanesthesia care unit after an open hemicolectomy. This client's plan of nursing care should prioritize which of the following? A) Assess the client hourly for signs of compartment syndrome. B) Assess the client's fine motor skills once per shift. C) Assess the client's wound for dehiscence every 4 hours. D) Maintain the client's head of bed at 45 degrees or more at all times.
ANS: C Postoperatively, the nurse assesses the client's responses to the surgery and monitors the client for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. Fine motor skills are unlikely to be affected by surgery and compartment syndrome is a complication of fracture casting, not abdominal surgery. There is no need to maintain a high head of bed.
The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the client is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A) Salvage surgery B) Palliative surgery C) Prophylactic surgery D) Reconstructive surgery
ANS: C 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.
A client with advanced leukemia is responding poorly to treatment. The nurse finds the client tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurse's most appropriate action? A) Tell him that you will give him privacy and leave the room. B) Offer to call pastoral care. C) Ask if he would like you to sit with him while he collects his thoughts. D) Tell him that you can understand how he's feeling.
ANS: C Providing emotional support and discussing the uncertain future are crucial. Leaving is incorrect because leaving the client doesn't show acceptance of his feelings. Offering to call pastoral care may be helpful for some clients but should be done after the nurse has spent time with the client. Telling the client that you understand how he's feeling is inappropriate because it doesn't help him express his feelings.
A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia (AML). When planning this client's care, the nurse should be aware of what epidemiologic fact? A) Early diagnosis is associated with good outcomes. B) Five-year survival for older adults is approximately 50%. C) Five-year survival for clients over 75 years old is less than 2%. D) Survival rates are wholly dependent on the client's preillness level of health.
ANS: C The 5-year survival rate for clients with AML who are 50 years of age or younger is 43%; it drops to 19% for those between 50 and 64 years, and drops to1.6% for those older than 75 years. Early diagnosis is beneficial, but is nonetheless not associated with good outcomes or high survival rates. Preillness health is significant, but not the most important variable.
The hospice nurse is caring for a client with cancer who is living at home. The nurse has explained to the client and the family that the client is at risk for hypercalcemia and has educated them on that signs and symptoms of this health problem. What else should the nurse teach this client and family to do to reduce the client's risk of hypercalcemia? A) Avoid the use of stool softeners B) Laxatives should be taken daily C) Consume 2 to 4 L of fluid daily D) Restrict calcium intake
ANS: C The nurse should identify clients at risk for hypercalcemia, assess for signs and symptoms of hypercalcemia, and educate the client and family. The nurse should teach at-risk clients to recognize and report signs and symptoms of hypercalcemia and encourage clients to consume 2 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease. Also, the nurse should explain the use of dietary and pharmacologic interventions, such as stool softeners and laxatives for constipation, and advise clients to maintain nutritional intake without restricting normal calcium intake.
A woman scheduled for a simple mastectomy in 1 week is having her preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period? A) Limit her intake of green leafy vegetables B) Increase her water intake to 8 glasses per day C) Stop taking aspirin D) Have nothing by mouth for 6 hours before surgery
ANS: C The nurse should instruct the client to stop taking aspirin due to its anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding. Increasing fluid intake or being NPO before surgery will have no effect on bleeding.
The nurse leading an educational session is describing self-examination of the breast. The nurse tells the women's group to raise their arms and inspect their breasts in a mirror. A member of the women's group asks the nurse why raising her arms is necessary. What is the nurse's best response? A) "It helps to spread out the fat that makes up your breast." B) "It allows you to simultaneously assess for pain." C) "It will help to observe for dimpling more closely." D) "This is what breast cancer experts recommend.
ANS: C The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the client to raise both arms overhead. Citing expert opinion does not address the woman's question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.
A nurse is talking with a client who is scheduled to have a hemicolectomy with the creation of a colostomy. The client admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. What nursing action is most appropriate? A) Reassure the client that the procedure is relatively low risk and that clients are usually successful in adjusting to an ostomy. B) Provide the client with educational materials that match the client's learning style. C) Encourage the client to write down these concerns and questions to bring forward to the surgeon. D) Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse.
ANS: D A wound-ostomy-continence (WOC) nurse is a registered nurse who has received advanced education in an accredited program to care for clients with stomas. The enterostomal nurse therapist can assist with the selection of an appropriate stoma site, teach about stoma care, and provide emotional support. The surgeon is less likely to address the client's psychosocial and learning needs. Reassurance does not address the client's questions, and education may or may not alleviate anxiety.
A nurse provides care on a bone marrow transplant unit and is preparing a female client for hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the client's family and friends? A) "Your family should likely gather at the bedside in case there's a negative outcome." B) "Make sure she doesn't eat any food in the 24 hours before the procedure." C) "Wear a hospital gown when you go into the client's room." D) "Do not visit if you've had a recent infection."
ANS: D Before HSCT, clients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the client's contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside.
the nurse is caring for a client has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The client states that he would like to die at home, but the team believes that the client's care needs are unable to be met in a home environment. What might the nurse suggest as an alternative? A) Discuss a referral for rehabilitation hospital. B) Panel the client for a personal care home. C) Discuss a referral for acute care. D) Discuss a referral for hospice care.
ANS: D Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the client and family. Clients who are referred to hospice care generally have fewer than 6 months to live. Each of the other listed options would be less appropriate for the client's physical and psychosocial needs.
A 35-year-old male is admitted to the hospital reporting severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this client suspects a diagnosis of what? A) AML B) CML C) MDS D) ALL
ANS: D In acute lymphocytic leukemia (ALL), manifestations of leukemic cell infiltration into other organs are more common than with other forms of leukemia, and include pain from an enlarged liver or spleen, as well as bone pain. The central nervous system is frequently a site for leukemic cells; thus, clients may exhibit headache and vomiting because of meningeal involvement. Other extranodal sites include the testes and breasts. This particular presentation is not closely associated with acute myeloid leukemia (AML), chronic myeloid leukemia (CML), or myelodysplastic syndromes (MDS).
An oncology client will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another? A) Adhering to primary tumor cells B) Inducing mutation of cells of another organ C) Phagocytizing healthy cells D) Invading healthy host tissues
ANS: D Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.
A client has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the client is most likely to require which of the following? A) Inpatient rehabilitation B) Rehabilitation in the home setting C) Intensive physical therapy D) Hospice care
ANS: D Pancreatic carcinoma has only a low survival rate regardless of the stage of disease at diagnosis or treatment. As a result, there is a higher likelihood that the client will require hospice care than physical therapy and rehabilitation.
A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The client has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this client most likely undergo? A) Lymphadenectomy B) Needle biopsy C) Open biopsy D) Sentinel node biopsy
ANS: D Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer.
A client has completed the full course of treatment for acute lymphocytic leukemia and has failed to respond appreciably. When preparing for the client's subsequent care, the nurse should perform what action? A) Arrange a meeting between the client's family and the hospital chaplain. B) Assess the factors underlying the client's failure to adhere to the treatment regimen. C) Encourage the client to vigorously pursue complementary and alternative medicine (CAM). D) Identify the client's specific wishes around end-of-life care.
ANS: D Should the client not respond to therapy, it is important to identify and respect the client's choices about treatment, including measures to prolong life and other end-of-life measures. The client may or may not be open to pursuing CAM. Unsuccessful treatment is not necessarily the result of failure to adhere to the treatment plan. Assessment should precede meetings with a chaplain, which may or may not be beneficial to the client and congruent with the family's belief system.
A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer? A) Development of new hemorrhoids B) Abdominal bloating and flank pain C) Unexplained weight gain D) Change in bowel habits
ANS: D The most common presenting symptom associated with colorectal cancer is a change in bowel habits. The passage of blood is the second most common symptom. Symptoms may also include unexplained anemia, anorexia, weight loss, and fatigue. Hemorrhoids and bloating are atypical.
A home health nurse is caring for a client discharged home after pancreatic surgery. The nurse documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the care plan based on the potential complications that may occur after surgery. What are the most likely complications for the client who has had pancreatic surgery? A) Proteinuria and hyperkalemia B) Hemorrhage and hypercalcemia C) Weight loss and hypoglycemia D) Malabsorption and hyperglycemia
ANS: D The nurse arrives at this diagnosis based on the complications of malabsorption and hyperglycemia. These complications often lead to the need for dietary modifications. Pancreatic enzyme replacement, a low-fat diet, and vitamin supplementation often are also required to meet the client's nutritional needs and restrictions. Electrolyte imbalances often accompany pancreatic disorders and surgery, but the electrolyte levels are more often deficient than excessive. Hemorrhage is a complication related to surgery, but not specific to the nutritionally based nursing diagnosis. Weight loss is a common complication, but hypoglycemia is less likely.
A client with Hodgkin lymphoma is receiving information from the oncology nurse. The client asks the nurse why it is necessary to stop drinking and smoking and stay out of the sun. What would be the nurse's best response? A) "Everyone should do these things because they're health promotion activities that apply to everyone." B) "You don't want to develop a second cancer, do you?" C) "You need to do this just to be on the safe side." D) "It's important to reduce other factors that increase the risk of second cancers."
ANS: D The nurse should encourage clients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight. The other options do not answer the client's question, and also make light of the client's question.
The nurse is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, what action should the nurse emphasize? A) Adjust the dose to the client's present symptoms. B) Wash hands with an alcohol-based cleanser following administration. C) Use gloves and a lab coat when preparing the medication. D) Dispose of the antineoplastic wastes in the hazardous waste receptacle.
ANS: D 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 the most plausible nursing diagnosis for a client whose treatment for colon cancer has necessitated a colostomy? A) Risk for Unstable Blood Glucose Due to Changes in Digestion and Absorption B) Unilateral Neglect Related to Decreased Physical Mobility C) Risk for Excess Fluid Volume Related to Dietary Changes and Changes In Absorption D) Ineffective Sexuality Patterns Related to Changes in Self-Concept
ANS: D The presence of an ostomy frequently has an effect on sexuality; this should be addressed thoughtfully in nursing care. None of the other listed diagnoses reflects the physiologic changes that result from colorectal surgery.
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? A) Limit the time that visitors spend at the client's bedside. B) Teach the client to perform all aspects of basic care independently. C) Assign male nurses to the client's care whenever possible. D) Situate the client in a shared room with other clients receiving brachytherapy.
ANS:A 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.