Med-Surg: Oncology

A nurse is caring for a postmenopausal client who is concerned that she might have an elevated risk of breast cancer. After conducting a risk assessment, the nurse should identify which of the following factors as increasing the client's breast cancer risk? (Select all that apply.) A. Increased breast density B. BMI of 32 C. Having given birth to 5 children D. Undergoing hormonal replacement therapy for 10 years E. Having 1-2 alcoholic drinks per week

A, B, D A. Increased breast density B. BMI of 32 D. Undergoing hormonal replacement therapy for 10 years - Women who have dense breast tissue are at an increased risk for developing breast cancer because they have more connective and glandular breast tissue. - Postmenopausal obesity increases the risk of developing breast cancer. - Hormone-related risks for developing breast cancer include the long-term use of oral contraceptives or hormone replacement therapy, early menarche, late menopause, and first pregnancy after 30 years of age. - C: Women who are nulliparous have a higher risk of developing breast cancer. - E: Consuming 3-14 alcoholic beverages per week increases the risk of developing breast cancer.

A nurse is caring for a client who recently had chemotherapy and now has myelosuppression. Which of the following interventions should the nurse initiate? (Select all that apply.) A. Prohibit visitors from bringing fresh flowers and plants into the client's room B. Encourage frequent visits from family and friends C. Ensure thorough cleaning of the client's room and bathroom daily D. Replace wound dressings every other day E. Use dedicated equipment such as stethoscopes

A, C, E A. Prohibit visitors from bringing fresh flowers and plants into the client's room C. Ensure thorough cleaning of the client's room and bathroom daily E. Use dedicated equipment such as stethoscopes - Myelosuppression is bone-marrow depression, which puts the client at a high risk of infection after chemotherapy. - Fresh flowers and potted plants can introduce microorganisms into the client's immediate environment. - Due to the client's high risk of infection, the nurse should make sure the housekeeping staff clean and sanitize the client's environment daily. - The nurse should utilize single-use equipment as much as possible and keep reusable equipment (e.g. stethoscopes and blood pressure cuffs) in the client's room for dedicated use by that client only.

A nurse on an oncology unit is providing discharge teaching to an adolescent female client who received bone marrow transplant for leukemia. Which of the following pieces of information should the nurse include in the teaching? (Select all that apply.) A. Take your temperature twice each day B. You may return to school if you feel strong enough C. It is important to wear shoes always D. Clean your toothbrush weekly with isopropyl alcohol E. Avoid using tampons

A, C, E A. Take your temperature twice each day C. It is important to wear shoes always E. Avoid using tampons - Clients who are postoperative from bone marrow transplants are immunosuppressed and should continually monitor for manifestations of infection. A temperature that is greater than 38c (100f) should be reported immediately to the provider. - The client should wear shoes to prevent injury and decrease the risk of infection. - The use of tampons is discouraged because they can disrupt the mucosal layer of the vagina and may support the growth of bacteria if left in place for too long. - B: Clients who have had a bone marrow transplant should avoid crowds such as those encountered at school, a mall, or a movie theater. They will also require time at home to recover and should limit visitors to individuals who are healthy. - D: Alcohol can cause trauma and irritation to the gums and tissues. Rinsing the toothbrush in a weak bleach solution and placing it in the dishwasher weekly are safer alternatives.

A nurse is providing teaching to a client who has cervical cancer and is scheduled to receive brachytherapy in an ambulatory care clinic. Which of the following statements by the client indicates an understanding of the teaching? A. I will need to lie still in bed during my brachytherapy treatment B. I will have an implant placed once a month during my brachytherapy treatment C. I must stay at least 3 feet away from others between brachytherapy treatments D. I should expect some blood in my urine after each brachytherapy treatment

A. I will need to lie still in bed during my brachytherapy treatment The nurse should confirm that the client understands the need to remain on bed rest with limited movement while the radioactive implant is in place to prevent dislodgment. - B: The nurse should explain that the provider often prescribed brachytherapy treatments 1 to 2 times per week. - C: The nurse should explain that the client does not emit any radiation between treatments; therefore, there are no restrictions regarding contact with others. - D: The nurse should explain that blood in the urine is not expected after brachytherapy treatment. The client should notify the provider immediately if she develops this manifestation.

A nurse in an oncology clinic is assessing a client who has early stage Hodgkin's lymphoma. Which of the following findings should the nurse expect? A. Bone and joint pain B. Enlarged lymph nodes C. Intermittent hematuria D. Productive cough

B. Enlarged lymph nodes Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. The first manifestation of this cancer is often an enlarged painless lymph node (or nodes) that appears without a known cause. Other early manifestations include night sweats, unexplained weight loss, fevers, and pruritus. The disease can spread to adjacent lymph nodes and later might spread outside the lymph nodes to the lungs, liver, bones, or bone marrow. The spread of Hodgkin's lymphoma usually occurs in an ordered pattern.

A nurse is providing teaching to a client following an open radical prostatectomy. The client is going home with an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching? A. I will be able to take a tub bath in 1 week B. I will change the catheter drainage bag once each week C. I will use suppositories to prevent constipation D. I will regain my bladder control once the catheter is removed

B. I will change the catheter drainage bag once each week The nurse should teach the client how to change the catheter drainage bag and explain the importance of changing the bag at least once each week. - A: The nurse should instruct the client to shower rather than take a tub bath for 2 to 3 weeks following an open radical prostatectomy. - C: The nurse should instruct the client to use stool softeners rather than suppositories to control constipation. - D: The nurse should inform the client that bladder control might not return immediately and to practice Kegel exercises, which can relieve incontinence. Urinary incontinence can last for 1 to 2 years following surgery.

A nurse is providing teaching to a client who has stomatitis due to chemotherapy and radiation therapy. Which of the following statements by the client indicates a need for further teaching? A. I will use a soft toothbrush or foam swabs for oral care B. I will use lemon and glycerin swabs after meals C. I will remove my dentures except while eating D. I will rinse my mouth frequently with hydrogen peroxide solution

B. I will use lemon and glycerin swabs after meals The client statement indicates a need for further teaching. The nurse should instruct the client who has stomatitis to avoid the use of lemon-glycerin swabs because they cause drying and irritation of the mucous membranes. - A: The nurse should instruct the client to provide oral care with a soft toothbrush or foam swab to prevent additional trauma or bleeding to oral tissues. - C: The nurse should instruct the client to remove dentures unless needed for eating due to potential irritation of the oral cavity. - D: The nurse should instruct the client to rinse the mouth with a hydrogen peroxide, warm saline, or baking soda solution every 2 to 3 hours to promote comfort and healing.

A nurse is planning a presentation at a community center about risk factors for cancer. Which of the following types of cancer should the nurse include when discussing familial clustering of specific types of cancer? A. Skin B. Prostate C. Bone D. Bladder

B. Prostate Types of cancer that typically demonstrate a familial tendency include breast, colorectal, ovarian, and prostate. - A: Skin cancer is not associated with a genetic risk - C: Bone cancer does not typically pose a genetic risk - D: Bladder cancer does not typically pose a genetic risk

A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing bladder cancer? A. The client is a hairdresser B. The client uses tobacco C. The client is over 60 years of age D. The client has frequent urinary tract infections (UTIs)

B. The client uses tobacco The client's tobacco use is the greatest risk factor for developing bladder cancer. - A, C, & D: These are all risk factors for developing bladder cancer, but tobacco use is the greatest risk factor.

A nurse is planning care for a client who is postoperative following a radical mastectomy. Which of the following interventions should the nurse include in the plan? A. Rest the arm on the affected side on the bed when the client is sleeping B. Instruct the client to keep the affected arm flexed when ambulating C. Begin exercises with the client 1 day after the procedure D. Maintain the client on bed rest for 2 days after the procedure

C. Begin exercises with the client 1 day after the procedure The nurse should plan to begin exercises that do not stress the incision on the first postoperative day to promote lymphatic return and mobility. - A: The nurse should plan to elevate the arm on the affected side when the client is in bed to promote the return of lymphatic fluid. - B: The nurse should plan to instruct the client to avoid flexing the affected arm while ambulating to reduce the risk of contractures. - D: The nurse should plan to ambulate the client on the first postoperative day to increase circulation, ventilation, and mobility.

A charge nurse is observing a newly licensed nurse provide care for a client who is receiving internal radiation therapy for the treatment of cervical cancer. For which of the following actions by the newly licensed nurse should the charge nurse intervene? A. Leaving soiled linens in a container in the client's room B. Instructing visitors to remain 2 m (6 feet) away from the client C. Borrowing a dosimeter film badge from another nurse before entering the client's room D. Removing an extra IV pole from the client's room to be used for another client

C. Borrowing a dosimeter film badge from another nurse before entering the client's room A nurse should never borrow a dosimeter film badge from another staff member. - Nurses who are caring for the client should each have a personal badge and wear it while in the client's room. The badge measures the radiation exposure that the nurse is receiving, and each film badge will indicate the nurse's cumulative radiation exposure. - A: The nurse should keep all dressings and linens in the client's room until after the radiation has been discontinued. - B: The nurse should instruct visitors to limit their time with the client to 30 minutes per day and to stay 2 m (6 ft) away from the client. - D: Equipment can be removed from the client's room at any time without special precautions. The equipment does not pose a hazard to other people because it is not emitting radiation. Items that should be given special consideration prior to removal are soiled dressings or linens.

A nurse is caring for a client who is postoperative following a urinary diversion to treat bladder cancer. Which of the following interventions should the nurse include in the plan of care? A. Empty the collection pouch when it is 2/3 full B. Expect urine outflow into the pouch to begin 1 to 2 days after surgery C. Change the collection pouch in the early morning D. Place an aspirin in the collection pouch to control odor

C. Change the collection pouch in the early morning The nurse should plan to change the urinary collection pouch in the early morning when urine output is reduced. - A: The nurse should empty the collection pouch when it is 1/3 full to prevent the excess weight of the urine causing the pouch to separate from the skin. - B: The nurse should expect no delay in urinary output following surgery. The nurse should monitor hourly urine output in the immediate postoperative period. Monitoring then continues every 4 to 8 hours. - D: The nurse should not use an aspirin in the collection pouch to control odor, as this can cause an ulceration of the stoma.

A nurse is providing preoperative teaching for a client with colorectal cancer who is scheduled to undergo colostomy placement with a perineal wound. Which of the following statements by the client indicates an understanding of the teaching? A. Not having any more rectal pain will be a relief B. I will need to sit on a rubber donut when I am in the chair C. I can have only liquids for 2 days before the surgery D. The colostomy will start working about 7 days after the surgery

C. I can have only liquids for 2 days before the surgery The client should consume a full or clear liquid diet for 24 to 48 hours before the surgery to decrease bulk. The client should consume a low-residue diet for several days prior to surgery to decrease peristalsis. - A: Following placement of a colostomy with a perineal wound, rectal sensations such as pain and itching might occur even after healing of the client's surgical wound. - B: The client should sit on foam pads or soft pillows and avoid the use of rubber donut devices, which increase pressure on the incisional site. - D: Following surgery, the client's colostomy should begin to function within 2 to 4 days.

A nurse is caring for a client who is receiving brachytherapy. Which of the following measures should the nurse include in the client's plan of care? A. Plan to spend extra time with the client to provide emotional support B. Ensure that chemotherapy medications do not extravasate into the client's tissues C. Keep the door to the client's room closed D. Encourage family members and friends to visit for at least 1 hr per day

C. Keep the door to the client's room closed Brachytherapy is a type of radiation therapy during which the radiation source is indirect contact with the client's tumor. During the therapy, the client emits radiation and is potentially hazardous to others. - The client should be in a private room with a private bathroom, and the nurse should keep the door to the client's room closed. - A: The nurse should organize tasks to limit the time spent with the client. - B: Brachytherapy does not involve chemotherapy medications; however, if a client is also receiving chemotherapy, this is an essential precaution. - D: The nurse should limit each visitor to 30 minutes per day and caution visitors to stay at least 2 m (6 feet) away from the client.

A nurse is caring for a client who is receiving chemotherapy to treat cancer. Which of the following adverse effects should the nurse anticipate from the chemotherapy? A. Gingival hyperplasia B. Hirsutism C. Pancytopenia D. Weight gain

C. Pancytopenia Pancytopenia (a deficiency of WBCs, RBCs, and platelet count) is an expected adverse effect of chemotherapy. - A: Gingival hyperplasia is not an adverse effect of chemotherapy. - B: Hirsutism, or excessive body or facial hair, is generally caused by Cushing syndrome, especially in women. The nurse should expect to see alopecia (hair loss) in a client who is receiving chemotherapy. - D: The client might have an inability or lack of desire to eat that causes weight loss due to the adverse effects of chemotherapy, such as metallic taste in the mouth, nausea, and vomiting.

A nurse is providing discharge teaching to a client who is post-operative following a right mastectomy for breast cancer. The client will be discharged with 2 Jackson-Pratt drains. Which of the following pieces of information should the nurse include in the teaching? A. Empty the drainage tubes once per day B. Showering is permitted before the drainage tubes are removed C. The drainage tubes often are removed at the same time as the stitches D. Do not begin exercising your arm until the provider removes the drainage tubes

C. The drainage tubes often are removed at the same time as the stitches The nurse should instruct the client that the provider will remove the drainage tubes at the same time the stitches are removed, usually within 7 to 10 days. - A: The nurse should instruct the client to empty the drainage tubes and record the amount of drainage twice each day. - B: The nurse should instruct the client to take baths until the provider removes the drainage tubes and stitches. - D: The nurse should instruct the client that normal use and non strenuous exercise are appropriate before the provider removes the drainage tubes. More strenuous exercise can begin following the removal of the drains.

A nurse is teaching a client how to perform a breast self-examination (BSE). The nurse should identify which of the following findings as an indication of breast cancer? A. Lumps that are mobile and tender on palpation prior to a menstrual period B. Multiple round masses that are tender and found in both breasts C. Bilaterally darkened areolas D. A non-tender, hard lump that is palpated in a breast

D. A non-tender, hard lump that is palpated in a breast Cancerous tumors are typically hard, fixed, irregular in shape, and non-tender to palpation. - A: Moveable lumps that increase in tenderness during the menstrual period are an indication of fibrocystic breast tissue - B: Multiple masses of regular shape in both breasts are characteristic of fibrocystic breast disease - C: Bilaterally darkened areoles are an expected finding in dark-skinned woman and an expected change during pregnancy in light-skinned women.

A nurse is collecting a health history from a female client who is undergoing screening for breast cancer. Which of the following factors increases the client's risk for developing breast cancer? A. Obesity B. Oral contraceptive use C. Alcohol use D. Age over 50 years

D. Age over 50 years A female client who is over 50 years of age has an increased risk of developing breast cancer. - A: Obesity moderately increases a client's risk of developing breast cancer. - B: Oral contraceptive use moderately increases a client's risk of developing breast cancer. - C: Alcohol use conveys a dose-dependent risk. Consumption of 3 to 14 drinks a week slightly increases a client's risk of developing breast cancer.

A client who has stage 2 breast cancer asks the nurse about sites of metastasis for this cancer. Which of the following responses should the nurse provide? A. It's too soon to worry about something that might not happen B. Breast cancer tends to metastasize to the stomach C. Metastasis is unlikely since we detected your cancer early D. Breast cancer tends to metastasize to the bones

D. Breast cancer tends to metastasize to the bones Common sites of breast cancer metastasis are the bones, lungs, brain, and liver.

A nurse is caring for a client who has lung cancer that has metastasized. Which of the following findings indicates the client is developing superior vena cava syndrome? A. Irregular cardiac rhythm B. Numbness in the hands C. Muscle cramps D. Facial edema

D. Facial edema Superior vena cava syndrome is a medical emergency resulting from a partial occlusion of the superior vena cava, leading to a decreased blood flow through the vein. - Most cases of superior vena cava syndrome are associated with cancers involving the client's upper chest (e.g. advanced lung and breast cancers and lymphoma). - The earliest manifestations of superior vena cava syndrome are facial and upper extremity edema. Death can result if the compression is not corrected. - A: It leads to alterations in client's vascular flow, not cardiac arrhythmias. - B: Numbness in the client's hands is a manifestation of spinal cord compression that can result if cancer spreads to the spinal cord. - C: Muscle cramps can indicate syndrome of inappropriate antidiuretic hormone (SIADH) and might occur with cancer metastasis to the brain.

A nurse is providing teaching to a client who has cancer and is undergoing external radiation treatment. Which of the following statements by the client indicates an understanding of the teaching? A. I should use petroleum-based lotions on the areas being radiated B. I will dry the areas being radiated by rubbing in a circular pattern C. I will apply sunscreen to the areas being radiated when I spend time in the sun D. I should use my hand, instead of a washcloth, to wash the areas being radiated

D. I should use my hand, instead of a washcloth, to wash the areas being radiated Washing the areas being radiated with the hand is gentler than using a washcloth. - A: No powders, lotions, ointments, or creams should be used on the areas being radiated unless prescribed by the provider. - B: The areas being radiated should be dried by gently patting, instead of rubbing. - C: The client should not apply sunscreen to the areas being radiated. Instead, the client should protect these areas by wearing clothing, staying in the shade when in intense sun, or avoiding sun exposure.

A nurse is collecting a client's health history. Which of the following findings is the highest risk factor for the client developing skin cancer? A. Age over 60 B. Genetic predisposition C. Light-skinned race D. Overexposure to sunlight

D. Overexposure to sunlight

A nurse is caring for a client who will receive brachytherapy to treat uterine cancer. The nurse should ensure the client understands that she will receive which of the following interventions? A. Chemotherapy via a central venous access device B. Radiation to the tumor from an external source C. Precise delivery of high-dose radiation after tumor imaging D. Radioactive infusion or insertions into or near the tumor

D. Radioactive infusion or insertions into or near the tumor Brachytherapy is a type of radiation therapy during which the radiation source, either an implant or via infusion, is in direct contact with the client's tumor continuously for a specific duration. - A: Chemotherapy is a chemical approach to killing cancer cells. Brachytherapy is not chemotherapy. - B: This intervention is teletherapy, not brachytherapy. - C: This intervention is stereotactic body radiotherapy, not brachytherapy.

A nurse is planning a presentation for a group of older adults at a community center about risk factors for cancer. Which of the following factors increases the risk of developing cancer after age 60? A. High-protein diet B. Insufficient calcium intake C. Declining muscle mass D. Weakened immune responses

D. Weakened immune responses After age 60, clients have a higher risk of cancer due to hormonal changes, altered immune responses, and the accumulation of free radicals. Age is a significant factor because the longer people are exposed to external carcinogenic factors (I.e. tobacco and alcohol use, environmental pollutants, radiation) the greater their risk of developing cancer becomes.