MedSurg Ch. 15
A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?
"I floss my teeth every morning."
A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed?
"I guess the doctor could not remove the entire tumor."
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?
Allogeneic
Which type of vaccine uses the patient's own cancer cells that are prepared for injection back into the patient?
Autologous
Which of the following does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure?
Blood studies
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
Which of the following occurs when there is accumulation of fluid in the pericardial space that compresses the heart?
Cardiac tamponade
Which oncologic emergency involves the accumulation of fluid in the pericardial space?
Cardiac tamponade
A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client?
Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects.
The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which of the following screening tests every 10 years?
Colonoscopy
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?
Control
The nurse is caring for a client newly diagnosed with cancer. Which of the following therapies is used to treat something other than cancer?
Electroconvulsive therapy
A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:
Encourage fluid intake, if possible, to dilute the urine.
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?
Extravasation
A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment?
For cancer of the bladder
The nurse is working with a patient who has had an allohematopoietic stem cell transplant (HSCT) and notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the patient has symptoms of which of the following?
Graft-versus-host disease
What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?
Ham and bacon
What can the nurse do to meet the challenges in caring for a patient with cancer?
Identify own perception of cancer and set realistic goals.
A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to:
Increase her intake of calcium-rich foods.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
Inspecting the skin for petechiae once every shift
Which of the following is a characteristic of a malignant tumor?
It gains access to the blood and lymphatic channels.
What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?
It lowers serum and uric acid levels.
A decrease in circulating white blood cells (WBC) is referred to as which of the following?
Leukopenia
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 bone marrow transplant?
Monitor the client closely to prevent infection.
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?
Monitor the client closely to prevent infection.
Which type of surgery is utilized in an attempt to relieve complications of cancer?
Palliative
The nurse at the clinic explains to the patient that the surgeon will be removing a mole on the patient's back that has the potential to develop into cancer. The nurse informs the patient that this is what type of procedure?
Prophylactic
You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer?
Prophylactic surgery
During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?
Providing a solution of viscous lidocaine for use as a mouth rinse
When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor?
Radiation can result in myelosuppression.
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?
Serum potassium level of 2.6 mEq/L
What should the nurse tell a female client who is about to begin chemotherapy and anxious about losing her hair?
She should consider getting a wig or cap before she loses her hair.
The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks?
Sun safety and use of sunscreen
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?
The I.V. site is red and swollen.
The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?
Tumor pressure against normal tissues
Your client is receiving radiation therapy. The client asks you about oral hygiene. What advice regarding oral hygiene should you offer?
Use a soft toothbrush and avoid an electronic toothbrush
Which of the following would be consistent with a benign neoplasm?
Usually progressive and slow
Which of the following would be inconsistent as a common side effect of chemotherapy?
Weight gain
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include:
chemotherapy exposure and risk factors.
The nurse is evaluating the client's risk for cancer and recommends changes when the client states she
eats red meat such as steaks or hamburgers every day
A decrease in circulating white blood cells is
leukopenia.
According to the TNM classification system, T0 means there is
no evidence of primary tumor.
The nurse is conducting a screening for familial predisposition of cancer. Which of the following should the nurse note as a possible indication of hereditary cancer syndrome?
An aunt and uncle diagnosed with cancer
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?
Anticipatory grieving
While doing a health history, a client tells you that her mother, grandmother, and sister died of cancer. The client wants to know what she can do to keep from getting cancer. What would be your best response?
"You can't prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is."
A patient is undergoing chemotherapy treatment for prostate cancer and has lost considerable weight due to nausea and vomiting. Which of the following nursing interventions is appropriate for the patient?
Adjusting meal plan before/after chemotherapy
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?
Administering metoclopramide and dexamethasone as ordered The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.
Which of the following is a sign or symptoms of septic shock?
Altered mental status
While administering cisplatin (Platinol-AQ) to a client, the nurse assesses swelling at the insertion site. The first action of the nurse is to
Discontinue the intravenous medication.
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?
Excisional biopsy
A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
Indigestion
When caring for a client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?
Inspect the skin frequently.
The nurse is caring for a patient undergoing an incisional biopsy. Which of the following statements does the nurse understand is true about an incisional biopsy?
It removes a wedge of tissue for diagnosis.
What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen?
It targets normal body cells as well as cancer cells.
A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately
Stops the chemotherapeutic infusion The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.
You are teaching clients about cancer prevention and explain that the root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) as a result from multiple factors. You explain that which of the following are possible carcinogens? Select all that apply.
• Viruses • Environmental factors • Dietary substances
The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.
• Egg white omelet with spinach and mushrooms • Steamed broccoli and carrots • Turkey breast on whole wheat bread
Nursing action for extravasation of a chemotherapeutic agent would include which of the following nursing actions? Select all that apply.
• Stop the medication infusion at the first sign of extravasation. • Aspirate any residual drug from the IV line. • Administer an antidote, if indicated.
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?
Avoiding using soap on the irradiated areas
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?
Stomatitis