Ch. 15 Med-Surg
The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue? a) 85% b) 95% c) 65% d) 75%
95% Explanation: The radiation dosage is dependent on the sensitivity of the target tissues to radiation and on the tumor size. The lethal tumor dose is defined as the dose that will eradicate 95% of the tumor yet preserve normal tissue.
A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis? a) White, cottage cheese-like patches on the tongue b) Rust-colored sputum c) Red, open sores on the oral mucosa d) Yellow tooth discoloration
Red, open sores on the oral mucosa Explanation: The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate? a) No further treatment is indicated. b) Repeat biopsy is needed before treatment begins. c) Palliative care is likely. d) Adjuvant therapy is likely.
Adjuvant therapy is likely. Explanation: T3 indicates a large tumor size with N1 indicating regional lymph node involvement. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor staging of stage IV is indicative of palliative care
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? a) "I'll not use my heating pad during my treatment." b) "I'll wear protective clothing when outside." c) "I'll wash my skin with mild soap and water only." d) "I'm worried I'll expose my family members to radiation."
"I'm worried I'll expose my family members to radiation." Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment? a) For cancer of the breast b) For cancer of the bladder c) For cancer of the lungs d) For skin cancer
For cancer of the bladder Explanation: Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer (Polovich et al, 2009).
A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? a) Disturbed body image b) Anticipatory grieving c) Impaired swallowing d) Chronic low self-esteem
Anticipatory grieving Explanation: Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn't associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn't disfiguring and doesn't cause Disturbed body image. Chronic low self-esteem isn't an appropriate nursing diagnosis at this time because the diagnosis has just been made.
The nurse is providing education to a patient with cancer radiation treatment options. The nurse determines that the patient understands when he or she states that which of the following types of radiation is aimed at protecting healthy tissue during the treatment? a) Brachytherapy b) Teletherapy c) Proton therapy d) External
Brachytherapy Explanation: In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body by use of an implant. With this type of therapy, the further the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.
The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? a) Monitor the client closely to prevent infection. b) Monitor the client's heart rate. c) Monitor the client's physical condition. d) Monitor the client's toilet patterns.
Monitor the client closely to prevent infection. Explanation: Until transplanted stem cells begin to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? a) Sodium level of 142 mEq/L b) Blood pressure of 120/64 to 130/72 mm Hg c) Urine output of 400 ml in 8 hours d) Serum potassium level of 2.6 mEq/L
Serum potassium level of 2.6 mEq/L Explanation: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings
The nurse is evaluating bloodwork results of a patient with cancer who is receiving chemotherapy. The patient's platelet count is 60,000/mm3. Which of the following is an appropriate nursing action? a) Providing commercial mouthwash to patient b) Providing patient with a razor to shave c) Avoiding use of products containing aspirin d) Taking patient's temperature rectally
Avoiding use of products containing aspirin Explanation: Patients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding use of products such as aspirin that may interfere with the patient's clotting systems; avoiding taking temperature rectally and administering suppositories; providing patient with an electric shaver for shaving; and avoiding commercial mouthwashes due to their potential to dry out oral mucosa, which can lead to cracking and bleeding.
The nurse is evaluating the client's risk for cancer and recommends changes when the client states she a) uses the treadmill for 30 minutes on 5 days each week b) drinks 1 glass of wine at dinner each night c) works as a secretary at a medical radiation treatment center d) eats red meat such as steaks or hamburgers every day
eats red meat such as steaks or hamburgers every day Explanation: Dietary substances such as nitrate-containing, nitrite-containing, and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. It is OK to drink 1 glass of wine per day.
A decrease in circulating white blood cells is a) leukopenia. b) granulocytopenia. c) neutropenia. d) thrombocytopenia.
leukopenia. Explanation: A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low ANC
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? a) "I'll wash my skin with mild soap and water only." b) "I'll wear protective clothing when outside." c) "I'll not use my heating pad during my treatment." d) "I'm worried I'll expose my family members to radiation."
"I'm worried I'll expose my family members to radiation." Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan? a) Wearing a lead apron during direct contact with the client b) Avoiding using soap on the irradiated areas c) Removing thoracic skin markings after each radiation treatment d) Applying talcum powder to the irradiated areas daily after bathing
Avoiding using soap on the irradiated areas Explanation: Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed
You are the nurse caring for a client with cancer. The client complains of pain and nausea. When assessed, you note that the client appears fearful. What other factor must you consider when a client with cancer indicates signs of pain, nausea, and fear? a) High cholesterol levels b) Ulceration c) Fatigue d) Infection
Fatigue Explanation: Clients with cancer experience fatigue, which is a side effect of cancer treatments that rest fails to relieve. The nurse must assess the client for other stressors that contribute to fatigue such as pain, nausea, fear, and lack of adequate support. The nurse works with other healthcare team members to treat the client's fatigue. The above indications do not contribute to infections, ulcerations, or high cholesterol levels.
A decrease in circulating white blood cells (WBC) is referred to as which of the following? a) Neutropenia b) Thrombocytopenia c) Granulocytopenia d) Leukopenia
Leukopenia Explanation: A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low absolute neutrophil count (ANC)
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? a) Temperature of 98.3° F (36.8° C) b) White blood cell (WBC) count of 9,000 cells/mm3 c) Ate 75% of all meals during the day d) Stage 3 pressure ulcer on the left heel
Stage 3 pressure ulcer on the left heel Explanation: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.
A patient with brain tumor is undergoing radiation and chemotherapy for treatment of cancer. Of late, the patient is complaining of swelling in the gums, tongue, and lips. Which of the following is the most likely cause of these symptoms? a) Neutropenia b) Extravasation c) Stomatitis d) Nadir
Stomatitis Explanation: The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.
