Cancer Study Questions

Lewis - Chapter 52 Questions

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566. The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted?

3. A platelet count of 50,000/mm3 Rationale: Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000/mm3. When the platelets are lower than 50,000/mm3, any small trauma can lead to episodes of prolonged bleeding. The normal white blood cell count is 4500 to 11,000/ mm3. When the white blood cell count drops, neutropenic precautions need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 10 to 80 mcg/dL.

534. The nurse is caring for a client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to:

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

544. The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor?

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

554. The client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy?

1. Biopsy of the tumor Rationale: A biopsy is done to determine whether a tumor is malignant or benign. Magnetic resonance imaging, computed tomography scan, and ultrasound will visualize the presence of a mass but will not confirm a diagnosis of malignancy.

1007. A community health nurse is preparing 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.

1. Family history of breast cancer 2. Early menarche 4. Previous cancer of the breast, uterus, or ovaries 6. High-dose radiation exposure to chest Rationale: Risk factors for breast cancer include family history of breast cancer; age older than 40 years; early menarche; late menopause; previous cancer of the breast, uterus, or ovaries; nulliparity or first child born after age 30 years; and highdose radiation exposure to chest.

974. A nurse has admitted a client to the clinical nursing unit after a modified right radical mastectomy for the treatment of breast cancer. The nurse plans to place the right arm in which of the following positions?

2. Elevated on a pillow Rationale: 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 3) or dependent (option 4), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery.

568. The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Cytoxan, Neosar). The nurse tells the client to:

2. Increase fluid intake to 2000 to 3000 mL daily. Rationale: Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide (Cytoxan, Neosar). The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

546. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which of the following assessment findings indicates that the colostomy is beginning to function?

2. The passage of flatus Rationale: Following abdominal perineal resection, the nurse would expect the colostomy to begin to function within 72 hours after surgery, although it may take up to 5 days. The nurse should assess for a return of peristalsis, listen for bowel sounds, and check for the passage of flatus. Absent bowel sounds would not indicate the return of peristalsis. The client would remain NPO until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from a colostomy.

545. The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is appropriate?

3. Change the dressing as prescribed. Rationale: Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected. The nurse does not need to notify the physician at this time. A Penrose drain should not be clamped because this action will cause the accumulation of drainage within the tissue. Penrose drains and packing are removed gradually over a period of 5 to 7 days as prescribed. The nurse should not remove the perineal packing.

567. 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?

3. Increased uric acid level Rationale: 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.

560. The clinic nurse prepares a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client:

3. To consult with health care providers before receiving immunizations Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a physician's or health care provider'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 effects.

553. The community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the clients to perform the examination:

4. 1 week after menstruation begins Rationale: The breast self-examination should be performed monthly 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.

556. Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy?

4. Weigh and measure the client on the day of medication administration. Rationale: To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total body surface area (BSA), which requires a current accurate height and weight for BSA calculation (before each medication administration). Asking the client about his or her height and weight may lead to inaccuracies in determining a true BSA and dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed.

44. The client with a new colostomy is being discharged. Which statement made by theclient indicates the need for further teaching?

A. "I should drink only liquids until the colostomy starts to work." R: The client should be on a regular diet, and the colostomy will have been working for several days prior to discharge. The client's statement indicates the need for further teaching.

29. The client is being discharged from the hospital for intractable pain secondary to cancer and is prescribed morphine, a narcotic. Which statement indicates the client understands the discharge instructions?

A. "I will be sure to have my prescriptions filled before any holiday." R: Narcotic medications require handwritten prescription forms (Drug Enforcement Agency rules) which must be filled within a limited time frame from the time the prescription is written. Many local pharmacies will not have the medication available or may not have it in the quantities needed. The client should anticipate the needs prior to any time when the HCP may not be available or the pharmacy may be closed.

39. The 85-year-old male client diagnosed with cancer of the colon asks the nurse, "Why did I get this cancer" Which statement is the nurse's best response?

A. "Research shows a lack of fiber in the diet can cause colon cancer." R: A long history of low-fiber, high-fat, and high-protein diets results in a prolonged transit time. This allows the carcinogenic agents in the waste products to have a greater exposure to the lumen of the colon.

25. The post-anesthesia care nurse is caring for the client diagnosed with lung cancer who had a thoracotomy and is experiencing frequent premature ventricular contractions (PVCs). Which intervention should the nurse implement first?

A. Assess for possible causes. R: The nurse should assess for possible causes of the PVCs; these causes may include hypoxia or hypokalemia.

2. The client is diagnosed with breast cancer and is considering whether to have a lumpectomy or a more invasive procedure, a modified radical mastectomy. Which information should the nurse discuss with the client?

A. Determine how the client feels about radiation and chemotherapy. R: The client should understand the treatment regimen for follow-up care. A lumpectomy requires follow-up with radiation therapy to the breast and then systemic chemotherapy. If the cancer is in its early stages, this regimen has results equal to those with a modified radical mastectomy.

43. The client complains to the nurse of unhappiness with the health-care provider. Which intervention should the nurse implement next?

A. Determine what about the HCP is bothering the client. R: The nurse should determine what is concerning the client. It could be a misunderstanding or a real situation where the client's care is unsafe or inadequate.

53. The client diagnosed with lung cancer has been told the cancer has metastasized to the brain. Which intervention should the nurse implement?

A. Discuss implementing an advance directive. R: This situation indicates a terminal process, and the client should make decisions for the end of life.

26. The nurse is caring for the client scheduled for an abdominal perineal resection for Stage IV colon cancer. Which client problem should the nurse include in the intraoperative care plan?

A. Impaired tissue perfusion. R: The perfusion of the surgical site is compromised as a result of the surgical incision, especially when a graft is used.

12. The client has been diagnosed with cancer of the breast. Which referral is most important for the nurse to make?

A. Reach to Recovery. R: Reach to Recovery is a specific referral program for clients diagnosed with breast cancer.

55. The nursing staff on an oncology unit are interviewing applicants for the unit manager position. Which type of organizational structure does this represent?

A. Shared governance. R: Shared governance is a system where the staff is empowered to make decisions such as scheduling and hiring of certain staff. Staff members are encouraged to participate in developing policies and procedures to reach set goals.

21. Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Check blood pressure (BP) on both right and left arms. b. Avoid isometric exercise on the right arm. c. Assist with application of a compression sleeve. d. Keep the right arm at or below the level of the heart.

ANS: C Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's right arm. The arm should not be placed in a dependent position.

1. The nurse teaching a young women's community service group about breast self-examination (BSE) will include that a. BSE will reduce the risk of dying from breast cancer. b. BSE should be done daily while taking a bath or shower. c. annual mammograms should be scheduled in addition to BSE. d. performing BSE after the menstrual period is more comfortable.

ANS: D Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women under age 40, and newer guidelines suggest delaying them until age 50.

16. The nurse will anticipate teaching a 56-year-old patient who is diagnosed with lobular carcinoma in situ (LCIS) about a. lumpectomy. b. lymphatic mapping. c. MammaPrint testing. d. tamoxifen (Nolvadex).

ANS: D Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

62. Which psychosocial client problem should the nurse write for the client diagnosed with cancer of the lung and metastasis to the brain?

A. Grieving. R: Metastasis indicates advanced disease, and the client should be allowed to express feelings of loss and grieving; the client is dying.

536. The nurse is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client's diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet?

1. Bowel sounds Rationale: The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options 2, 3, and 4 are unrelated to the subject of the question.

562. The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse contacts the physician before administering the medication if which of the following is documented in the client's history?

1. Pancreatitis Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administrations. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

555. A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? Select all that apply.

1. Radiation 2. Chemotherapy 4. Serum sodium levels 6. Medication that is antagonistic to antidiuretic hormone Rationale: Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

535. The home health care nurse is caring for a client with cancer and the client is complaining of acute pain. The most appropriate nursing assessment of the client's pain would include which of the following?

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

564. The client with metastatic breast cancer is receiving tamoxifen (Nolvadex). The nurse specifically monitors which laboratory value while the client is taking this medication?

2. Calcium level Rationale: Tamoxifen (Nolvadex) may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

549. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?

2. Elevating the affected arm on a pillow above heart level Rationale: Following mastectomy, the arm should be elevate 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.

548. The nurse is assessing the stoma of a client following a ureterostomy. Which of the following should the nurse expect to note?

4. A red and moist stoma Rationale: Following ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate amount of vascular supply. A dry stoma may indicate a body fluid deficit. Any sign of darkness or duskiness in the stoma may indicate a loss of vascular supply and must be reported immediately or necrosis can occur.

559. The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse monitors the client during administration, knowing that which side effect is specifically associated with this medication?

4. Orthostatic hypotension Rationale: A side effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications Chest pain and pulmonary fibrosis are unrelated to this medication.

7. The client who is scheduled to have a breast biopsy with sentinel node dissection states, "I don't understand. What does a sentinel node biopsy do?" Which scientific rationale should the nurse use to base the response?

A. A dye is injected into the tumor and traced to determine spread of cells. R: A sentinel node biopsy is a procedure in which a radioactive dye is injected into the tumor and then traced by instrumentation and color to try to identify the exact lymph nodes the tumor could have shed into.

26. A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? a. "Tell me what you think is important to know about the surgery." b. "It is essential that you know enough to provide informed consent." c. "Many patients do better after surgery if they have more information." d. "You can wait until after surgery for teaching about pain management."

ANS: A This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences.

12. The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include? a. Saline-filled implants are placed under the pectoral muscles. b. Recovery from the TRAM surgery takes at least 6 to 8 weeks. c. Muscle tissue removed from the back is used to form a breast. d. TRAM flap procedures may be done in outpatient surgery centers.

ANS: B Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires postoperative hospitalization. Saline implants are used in mammoplasty.

8. After a 48-year-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about a. estradiol (Estrace). b. raloxifene (Evista). c. tamoxifen (Nolvadex). d. trastuzumab (Herceptin).

ANS: C Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.

532. The nurse is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which principle?

2. Do not allow pregnant women into the client's room. Rationale: The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8- hour shift. The dosimeter film badge must be worn when in the client's room. Children younger than 16 years of age and pregnant women are not allowed in the client's room.

11. The client who has had a mastectomy tells the nurse, "My husband will leave me now since I am not a whole woman anymore." Which response by the nurse is most therapeutic?

A. "You're afraid your husband will not find you sexually appealing." R: This is restating the client's feelings and is a therapeutic response.

4. Which recommendation is the American Cancer Society's (ACS) guideline for the early detection of breast cancer?

A. Beginning at age 40, receive a yearly mammogram. R: The ACS recommends a yearly mammogram for the early detection of breast cancer. A mammogram can detect disease that will not be large enough to feel.

40. The nurse is planning the care of a client who has had an abdominal-perineal resection for cancer of the colon. Which interventions should the nurse implement? Select all that apply.

A. Provide meticulous skin care to stoma. R: Colostomy stomas are openings through the abdominal wall into the colon, through which feces exit the body. Feces can be irritating to the abdominal skin, so careful and thorough skin care is needed. A. Maintain the indwelling catheter. R: Because of the perineal wound, the client will have an indwelling catheter to keep urine out of the incision. A. Position the client semirecumbent. R: The client should not sit upright because this causes pressure on the perineum.

570. The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. 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 should take which actions? Select all that apply.

1. Stop the infusion. 2. Notify the physician. 3. Prepare to apply ice or heat to the site. 5. Prepare to administer a prescribed antidote into the site. Rationale: Redness and swelling and a slowed infusion indicate signs of extravasation. If extravasation occurs during the intravenous administration of an antineoplastic medication, the infusion is stopped and the physician 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.

563. Tamoxifen (Nolvadex) is prescribed for the client with metastatic breast carcinoma. The nurse administering the medication understands that the primary action of this medication is to:

4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale: Tamoxifen (Nolvadex) is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

56. The client diagnosed with lung cancer is being discharged. Which statement made by the client indicates more teaching is required?

A. "It doesn't matter if I smoke now. I already have cancer." R: Research indicates smoking will still interfere with the client's response to treatment, so more teaching is needed.

2. During a well woman physical exam, a 43-year-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? a. "Do you currently smoke tobacco?" b. "Have you ever had a breast injury?" c. "At what age did you start having menstrual periods?" d. "Is there a family history of fibrocystic breast changes?"

ANS: C Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

19. The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first? a. Teach the patient how to deep breathe and cough. b. Discuss options for postoperative pain management. c. Explain the postdischarge care of the axillary drains. d. Ask the patient to describe what she knows about the surgery.

ANS: D Before teaching, the nurse should assess the patient's current knowledge level. The other teaching also may be appropriate, depending on the assessment findings.

8. The client who is four (4) months pregnant finds a lump in her breast and the biopsy is positive for Stage II cancer of the breast. Which treatment should the nurse anticipate the HCP recommending to the client

A. A modified radical mastectomy. R: A modified radical mastectomy is recommended for this client because the client is not able to begin radiation or chemotherapy, which are part of the regimen for a lumpectomy or wedge resection. Many breast cancers developed during pregnancy are hormone sensitive and have the ideal grounds for growth. The tumor should be removed as soon as possible.

13. A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? a. "There are several options that I can consider for treating the cancer." b. "I will probably need radiation to the breast after having the surgery." c. "Mastectomy is the best choice to decrease the chance of cancer recurrence." d. "I can probably have reconstructive surgery at the same time as a mastectomy."

ANS: C The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.

27. The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first? a. 57-year-old with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching b. 21-year-old with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene c. 40-year-old who still has left side chest and arm pain 2 months after a left modified radical mastectomy d. 50-year-old with stage 2 breast cancer who is receiving doxorubicin (Adriamycin) and has ankle swelling and fatigue

ANS: D Although all the patients have needs that the nurse should address, the patient who is receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by the nurse first. BRCA testing may be appropriate for the 21-year-old, but it does not need to be done immediately. Chest and arm pain are normal up to 3 months after mastectomy. Nipple discharge and itching is a common finding with ductal ectasia.

52. The client diagnosed with breast cancer has developed metastasis to the brain. Which prophylactic measure should the nurse implement?

A. Initiate seizure precautions. R: The client diagnosed with metastatic lesions to the brain is at high risk for seizures.

46. The nurse is caring for clients in an outpatient clinic. Which information should the nurse teach regarding the American Cancer Society's recommendations for the early detection of colon cancer?

A. Have a colonoscopy at age 50 and then once every five (5) to 10 years. R: The American Cancer Society recommends a colonoscopy at age 50 and every five (5) to 10 years thereafter, and a flexible sigmoidoscopy and a barium enema every five (5) years.

48. The client presents with a complete blockage of the large intestine from a tumor. Which health-care provider's order would the nurse question

A. Administer 3 liters of GoLYTELY. R: This client has an intestinal blockage from a solid tumor blocking the colon. Although the client needs to be cleaned out for the colonoscopy, GoLYTELY could cause severe cramping without a reasonable benefit to the client and could cause a medical emergency.

50. The nurse writes a problem of "impaired gas exchange" for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care? Select all that apply.

A. Apply O2 via nasal cannula. R: Respiratory distress is a common finding in clients diagnosed with lung cancer. As the tumor grows and takes up more space or blocks air movement, the client may need to be taught positioning for lung expansion. The administration of oxygen will help the client to use the lung capacity that is available to get oxygen to the tissues. A. Have the dietitian plan for six (6) small meals per day. R: Clients with lung cancer frequently become fatigued trying to eat. Providing six (6) small meals spaces the amount of food the client eats throughout the day. A. Assess vital signs for fever. R: Clients with cancer of the lung are at risk for developing an infection from lowered resistance as a result of treatments or from the tumor blocking secretions in the lung. Therefore, monitoring for the presence of fever, a possible indication of infection, is important. A. Listen to lung sounds every shift. R: Assessment of the lungs should be completed on a routine and PRN basis.

3. The client has undergone a wedge resection for cancer of the left breast. Which discharge instruction should the nurse teach?

A. Don't lift more than five (5) pounds with the left hand until released by the HCP. R: The client has had surgery on this side of the body. Pressure on the incision should be limited until the client is released by the HCP to perform normal daily activities.

37. The occupational health nurse is preparing a presentation to a group of factory workers about preventing colon cancer. Which information should be included in the presentation?

A. Eat several servings of cruciferous vegetables daily. R: Cruciferous vegetables, such as broccoli, cauliflower, and cabbage, are high in fiber. One of the risks for cancer of the colon is a high-fat, low-fiber, and high-protein diet. The longer the transit time (the time from ingestion of the food to the elimination of the waste products), the greater the chance of developing cancer of the colon.

41. The client who has had an abdominal perineal resection is being discharged. Which discharge information should the nurse teach?

A. Empty the pouch when it is one-third to one-half full. R: The pouch should be emptied when it is one-third to one-half full to prevent the contents from becoming too heavy for the seal to hold and to prevent leakage from occurring.

60. The client diagnosed with oat cell carcinoma of the lung tells the nurse, "I am so tired of all this. I might as well just end it all." Which statement should be the nurse's first response?

A. Find out if the client has a plan to carry out suicide. R: The priority action anytime a client makes a statement regarding taking his or her own life is to determine if the client has thought it through enough to have a plan. A plan indicates an emergency situation.

54. The client diagnosed with lung cancer is in an investigational program and receiving a vaccine to treat the cancer. Which information regarding investigational regimens should the nurse teach?

A. Investigational treatments have not been proven to be helpful to clients. R: Investigational treatments are just that—treatments being investigated to determine if they are effective in the care of clients diagnosed with cancer. There is no guarantee the treatments will help the client.

42. The nurse caring for a client one (1) day postoperative sigmoid resection notes a moderate amount of dark reddish brown drainage on the midline abdominal incision. Which intervention should the nurse implement first?

A. Mark the drainage on the dressing with the time and date. R. The nurse should mark the drainage on the dressing to determine if active bleeding is occurring, because dark reddish-brown drainage indicates old blood. This allows the nurse to assess what is actually happening.

28. The client diagnosed with cancer is experiencing severe pain. Which regimen would the nurse teach the client about to control the pain?

A. Morphine sustained release, a narcotic, routinely with a liquid morphine preparation for breakthrough pain. R: Morphine is the drug of choice for cancer pain. There is no ceiling effect, it metabolizes without harmful byproducts, and it is relatively inexpensive. A sustained-release formulation, such as MS Contin, is administered every six (6) to eight (8) hours, and a liquid fast-acting form is administered sublingually for any pain which is not controlled.

10. The client is being discharged after a left wedge resection. Which discharge instructions should the nurse includeSelect all that apply.

A. Notify the HCP of a temperature of 100˚F. R: It is a common instruction for any client who has had surgery to notify the HCP if a fever develops. This could indicate a postoperative infection. A. Carry large purses and bundles with the right hand. R: The client who has had a mastectomy is at risk for lymphedema in the affected arm because the lymph nodes are removed during the surgery. The client should protect the arm from injury and carry heavy objects with the opposite arm. A. Have a mammogram of the right and left breast yearly. R: The client has developed a malignancy in one breast and is at a higher risk for developing another tumor in the remaining breast area.

9. The client who had a right modified radical mastectomy four (4) years before is being admitted for a cardiac workup for chest pain. Which intervention is most important for the nurse to implement?

A. Post a message at the head of the bed to not use the right arm. R: The nurse should post a message at the head of the client's bed to not use the right arm for blood pressures or laboratory draws. This client is at risk for lymphedema, and this is a lymphedema precaution.

47. The nurse writes a psychosocial problem of "risk for altered sexual functioning related to new colostomy." Which intervention should the nurse implement?

A. Teach the client to protect the pouch from becoming dislodged during sex. R: A pouch that becomes dislodged during the sexual act would cause embarrassment for the client, whose body image has already been dealt a blow.

59. The client is admitted to the outpatient surgery center for a bronchoscopy to rule out cancer of the lung. Which information should the nurse teach?

A. The HCP can do a biopsy of the tumor through the scope. R: The HCP can take biopsies and perform a washing of the lung tissue for pathological diagnosis during the procedure.

58. The client is four (4) hours post-lobectomy for cancer of the lung. Which assessment data warrant immediate intervention by the nurse?

A. The client has 450 mL of bright-red drainage in the chest tube. R: This is about a pint of blood loss and could indicate the client is hemorrhaging.

57. The clinic nurse is interviewing clients. Which information provided by a client warrants further investigation?

A. The client has been coughing up blood in the mornings. R: Coughing up blood is not normal and is cause for investigation. It could indicate lung cancer.

38. The nurse is admitting a client to a medical floor with a diagnosis of adenocarcinoma of the rectosigmoid colon. Which assessment data support this diagnosis?

A. The client has diarrhea alternating with constipation. R: The most common symptom of colon cancer is a change in bowel habits, specifically diarrhea alternating with constipation.

49. The nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung. Which information is significant for this disease?

A. The client has smoked two (2) packs of cigarettes a day for 20 years. R: Smoking is the number-one risk factor for developing cancer of the lung. More than 85% of lung cancers are attributable to inhalation of chemicals. There are more than 400 chemicals in each puff of cigarette smoke, 17 of which are known to cause cancer.

26. The nurse is caring for the postoperative client diagnosed with lung cancer recovering from a thoracotomy. Which data require immediate intervention by the nurse?

A. The client is coughing up pink frothy sputum. R: Pink frothy sputum indicates pulmonary edema and would require immediate intervention.

52. The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a medical unit. Which information provided by the UAP warrants immediate intervention by the nurse?

A. The client receiving Procrit, a biologic response modifier, has a T 99.2˚F, P 68, R 24, and BP of 198/102. R: Biologic response modifiers stimulate the bone marrow and can increase the client's blood pressure to dangerous levels. This BP is high and warrants immediate attention.

1. The client frequently finds lumps in her breasts, especially around her menstrual period. Which information should the nurse teach the client regarding breast self-care?

A. The client should practice breast self-examination monthly. R: The American Cancer Society no longer recommends breast self-examination (BSE) for all women, but it is advisable for women with known breast conditions to perform BSE monthly to detect potential cancer.

10. The client with a diagnosis of rule-out colon cancer is two (2) hours post-sigmoidoscopy procedure. Which assessment data warrant immediate intervention by the nurse?

A. The client's BP is 96/60 and apical pulse is 108. R: These are signs/symptoms of hypovolemic shock requiring immediate intervention by the nurse.

43. The nurse is teaching the client diagnosed with colon cancer who is scheduled for a colostomy. Which behavior indicates the nurse is utilizing adult learning principles

A. The nurse repeats the information as indicated by the client's questions. R: The nurse should realize the client is anxious about the diagnosis of cancer and the impending surgery. Therefore, the nurse should be prepared to repeat information as necessary. The learning principle the nurse needs to consider is "anxiety decreases learning."

6. The nurse is teaching a class on breast health to a group of ladies at a senior citizen's center. Which risk factor is the most important to emphasize to this group?

A. The older a woman gets, the greater the chance of developing breast cancer. R: The greatest risk factor for developing breast cancer is being female. The second greatest risk factor is being elderly. By age 80, one (1) in every eight (8) women develops breast cancer.

5. The client had a mastectomy for cancer of the breast and asks the nurse about a TRAM flap procedure. Which information should the nurse explain to the client?

A. The surgeon will pull the client's own tissue under the skin to create a breast. R: The TRAM flap procedure is one in which the client's own tissue is used to form the new breast. Abdominal tissue and fat are pulled under the skin with one end left attached to the site of origin to provide circulation until the body builds collateral circulation in the area.

15. A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which item should the charge nurse suggest that the student nurse omit from the teaching topic list about breast cancer diagnostic testing? a. CA 15-3 level testing b. HER-2 receptor testing c. Estrogen receptor testing d. Oncotype DX assay testing

ANS: A Tumor markers such as CA 15-3 are used to monitor response to treatment for breast cancer, not to detect or diagnose breast cancer. The other tests are likely to be used for additional diagnostic testing in a patient with breast cancer.

6. A 58-year-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? a. "I would have a lumpectomy, but you need to decide what is best for you." b. "Tell me what you understand about the surgical options that are available." c. "It would not be appropriate for me to make a decision about your health." d. "There is no need to make a decision rapidly; you have time to think about this."

ANS: B Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurse's opinions or showing an unwillingness to discuss the topic could cut off communication.

4. Which assessment finding in a 36-year-old patient is most indicative of a need for further evaluation? a. Bilateral breast nodules that are tender with palpation b. A breast nodule that is 1 cm in size, nontender, and fixed c. A breast lump that increases in size before the menstrual period d. A breast lump that is small, mobile, with a rubbery consistency

ANS: B Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.

18. Which patient statement indicates that the nurse's teaching about tamoxifen (Nolvadex) has been effective? a. "I can expect to have leg cramps." b. "I will call if I have any eye problems." c. "I should contact you if I have hot flashes." d. "I will be taking the medication for 6 to 12 months."

ANS: B Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

17. Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? a. The radiation therapy will take a week to complete. b. Careful skin care in the radiated area will be necessary. c. Visitors are restricted until the radiation therapy is completed. d. Wigs may be used until the hair regrows after radiation therapy.

ANS: B Skin care will be needed because of the damage caused to the skin by the radiation. External beam radiation is done over a 5- to 6-week period. Scalp hair loss does not occur with breast radiation therapy. Because the patient does not have radioactive implants, no visitor restrictions are necessary.

10. The nurse provides discharge teaching for a 61-year-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful? a. "I will need to use my right arm and to rest the left one." b. "I will avoid reaching over the stove with my left hand." c. "I will keep my left arm in a sling until the incision is healed." d. "I will stop the left arm exercises if moving the arm is painful."

ANS: B The patient should avoid any activity that might injure the left arm, such as reaching over a burner. If the left arm exercises are painful, analgesics should be used and the exercises continued in order to restore strength and range of motion. The left arm should be elevated at or above heart level and should be used to improve range of motion and function.

11. A 33-year-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? a. Take aspirin every 4 hours to reduce inflammation. b. Check wound drains for excessive blood or a foul odor. c. Wear a loose-fitting bra to decrease irritation of the sutures. d. Resume normal activities 2 to 3 days after the mammoplasty.

ANS: B The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.

5. A 53-year-old woman at menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. b. HT does not appear to increase the risk for breast cancer unless there are other risk factors. c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.

ANS: C Because HT has been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

25. The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the health care provider? a. The patient complains of fatigue. b. The patient eats only 25% of meals. c. The patient's apical pulse is irregular. d. The patient's white blood cell (WBC) count is 5000/µL.

ANS: C Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.

9. Which nursing action should be included in the plan of care for a patient returning to the surgical unit following a left modified radical mastectomy with dissection of axillary lymph nodes? a. Obtain a permanent breast prosthesis before the patient is discharged from the hospital. b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. c. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. d. Insist that the patient examine the surgical incision when the initial dressings are removed.

ANS: C The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.

7. The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that a. hot flashes may occur with the medication. b. serum electrolyte levels will be drawn monthly. c. the patient will need frequent eye examinations. d. the patient should call if she notices ankle swelling.

ANS: D Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab.