MedSurg: Saunders Oncology
The community health nurse conducts a health promotion program for community members regarding testicular cancer. The nurse determines that further information needs to be provided if a community member states that which is a sign of testicular cancer? 1. Alopecia 2. Back pain 3. Painless testicular swelling 4.Heavy sensation in the scrotum
Answer: 1. Alopecia Rationale: Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. The remaining options are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.
The oncology nurse is providing a teaching session for a group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student would indicate a need for further teaching? 1. "Bladder cancer most often occurs in women." 2. "Using cigarettes and drinking coffee can increase the risk." 3. "Bladder cancer generally is seen in clients older than age 40." 4."Environmental health hazards have been implicated as a cause."
Answer: 1. "Bladder cancer most often occurs in women." Rationale: The incidence of bladder cancer is greater in men than in women and affects white people twice as often as black people. The remaining options describe risks associated with bladder cancer.
The nurse is reviewing the record of a client who was admitted to the hospital with a diagnosis of ovarian cancer. A client has received an unsealed radioactive isotope for treatment of thyroid cancer. Which instruction is essential for the nurse to provide the client? 1. "Flush the toilet at least 3 times after use." 2. "Increase intake of fruits with a core, such as apples and pears." 3. "Avoid contact with pregnant women, infants, and children for 3 months." 4. "Use disposable eating utensils, plates, and cups for the next 6 months."
Answer: 1. "Flush the toilet at least 3 times after use. Rationale: Bodily fluids contain the radioactive material, so others should be shielded from possible exposure. Clients should at best have a dedicated toilet for use during the first 2 weeks and should also flush 3 times after use. Some radioactivity will be in the saliva for about the first week, so during this time fruits with cores that will become contaminated should be avoided. Disposable eating utensils should also be used during this period of time. Contact with pregnant women, infants, and children is avoided for the first week and then a distance of 3 feet (1 meter) or more should be maintained and exposure should be limited to 1 hour per day.
The nurse is doing preoperative teaching with a client newly diagnosed with a stage I cervical cancer. Which statement by the client indicates that education was effective? 1. "I have carcinoma that is just in the cervix." 2. "My carcinoma has extended to the pelvis and the vagina." 3. "I have carcinoma that has extended beyond the cervix but has not extended to the pelvic wall." 4. "My carcinoma has extended beyond the true pelvis and has involved the bladder or rectal mucosa."
Answer: 1. "I have carcinoma that is just in the cervix." Rationale: Stage I carcinoma is strictly confined to the cervix. In stage II, the carcinoma has extended beyond the cervix but has not extended to the pelvic wall. Stage III carcinoma has extended to the pelvic wall at the lower third of the vagina, and stage IV carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum.
The nurse is taking a history from a client suspected of having testicular cancer. Which data will be most helpful in determining the risk factors for this type of cancer? 1. Age and race 2. Marital status 3. Number of children 4.Number of sexual partners
Answer: 1. Age and race Rationale: Two basic but important risk factors for testicular cancer are age and race. The disease occurs most frequently in white males, generally between the ages of 15 and 34 years. Other risk factors include a history of undescended testis and a family history of testicular cancer. Marital status and number of children are not associated with increased risk of testicular cancer. In addition, the number of sexual partners is not associated with testicular cancer.
The nurse is performing a skin assessment on a client diagnosed with malignant melanoma. The nurse should expect to note which characteristic of this type of skin lesion? 1. An irregularly shaped lesion 2. A small papule with a dry, rough scale 3. A firm nodular lesion topped with crust 4. A pearly papule with a central crater and a waxy border
Answer: 1. An irregularly shaped lesion Rationale: A melanoma is an irregularly shaped pigmented papule or plaque with a red, white, or blue tone. Actinic keratosis, a premalignant lesion, appears as a small macule or papule with a dry, rough adherent yellow or brown scale. Squamous cell carcinoma is a firm nodular lesion topped with a crust or a central area of ulceration. Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border.
A cervical radiation implant is placed in a client who is undergoing treatment of cervical cancer. The nurse should initiate which activity prescription as the most appropriate for this client? 1. Bed rest 2. Out of bed ad lib 3. Out of bed in a chair only 4.Ambulation to the bathroom only
Answer: 1. Bed rest Rationale: The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.
A client is admitted to the nursing unit after undergoing radical prostatectomy for cancer. The nurse anticipates that which problem would be of most concern to the client in the immediate postoperative period? 1. Concern about the outcome of surgery 2. Continuous pain because of the effects of cancer 3. Appearance disturbance as a result of the presence of a suprapubic catheter 4. Concern about caring for self at home because of insufficient help after discharge
Answer: 1. Concern about the outcome of surgery Rationale: In the immediate postoperative period, the client who has had surgery for cancer may experience fear or concern related to the uncertain outcome of surgery. Postoperative pain is classified as acute, not continuous. The client may experience an alteration in appearance, but this is more likely to be related to the anticipated change in sexual function than the presence of the suprapubic catheter. The priority focus in the immediate postoperative period is not on concerns that apply to hospital discharge.
The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4.Monitoring the red blood cell count
Answer: 1. Encouraging fluids Rationale: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client.
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4.Decreased number of plasma cells in the bone marrow
Answer: 1. Increased calcium level Rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.
The nurse is counseling a woman about decreasing her risk for cervical cancer. Which statement by the client indicates a need for further counseling? 1. "I need to seek prompt treatment for vaginitis." 2. "Condoms are needed only if I do not trust a new partner." 3. "A partner who is uncircumcised will present an increased risk." 4. "I need to keep appointments for Pap tests at the frequency advised by my health care provider."
Answer: 2. "Condoms are needed only if I do not trust a new partner." Rationale: Condoms should be used for adequate protection, especially with new partners. Sexually transmitted infections (which could be acquired without condom use) increase the client's risk of cervical cancer. Uncircumcised partners may present an increased risk. The woman should adhere to guidelines for early detection of cervical cancer (by Pap test) and should seek prompt treatment of vaginitis and cervicitis if they occur.
The nurse has provided instructions to a client regarding testicular self-examination (TSE). Which client statement indicates the need for further teaching regarding TSE? 1. "I know to report any small lumps." 2. "I examine myself every 2 months." 3. "I examine myself after I take a warm shower." 4. "I feel a hard and cord-like thing in back and going up."
Answer: 2. "I examine myself every 2 months." Rationale: TSE should be performed every month. Small lumps or abnormalities should be reported. The spermatic cord finding (option 4) is normal. After a warm bath or shower, the scrotum is relaxed, making it easier to perform TSE.
The community nurse is conducting a health promotion program, and the topic of the discussion relates to the risk factors for gastric cancer. Which item, if identified as a risk factor by a client, indicates a need for further discussion? 1. Smoking 2. A low-fat diet 3. Foods containing nitrates 4.A diet of smoked, highly salted, and spiced foods
Answer: 2. A low-fat diet Rationale: A low-fat diet is not a risk factor for gastric cancer. A high-fat diet plays a role in the development of cancer of the pancreas and other types of cancers. The remaining options are risk factors related to gastric cancer.
The clinic nurse has conducted a health screening clinic to identify clients who are at risk for cervical cancer. The nurse is reviewing the assessment findings in the records of the clients who attended the clinic. Which client is at lowest risk for developing this type of cancer? 1. A multiparity client 2. A single white client 3. A client with a history of chronic cervicitis 4. A client who had early, frequent intercourse with multiple sexual partners
Answer: 2. A single white client Rationale: Risk factors associated with cervical cancer include early, frequent intercourse with multiple sexual partners; multiparity; chronic cervicitis; and a history of genital herpes or human papilloma. Cervical cancer also occurs with higher frequency in African Americans. Regarding the options provided, the single white client is at lowest risk for the development of cervical cancer.
The nurse is caring for a client with leukemia. In assessing the client for signs of leukemia, the nurse determines that what should be monitored? 1. Platelet count 2. Bone marrow biopsy 3. White blood cell count 4. Complete blood cell count
Answer: 2. Bone marrow biopsy Rationale: Bone marrow aspiration or biopsy allows examination of blast cells and other hypercellular activity. Blood studies will not provide a definitive diagnosis of leukemia.
The nurse has conducted a cancer prevention seminar for clients in an ambulatory setting. The nurse determines that teaching was effective if the clients select which food item on the menu? 1. Broiled beef, canned corn, rice 2. Broccoli, baked fish, mashed potato 3. Bacon, scrambled eggs, french fries 4. Bologna, canned asparagus, white bread
Answer: 2. Broccoli, baked fish, mashed potato Rationale: Broccoli is a cruciferous vegetable, which is helpful in reducing the risk of cancer. Other cruciferous vegetables are cauliflower, Brussels sprouts, and cabbage. Red meat (bacon) and meats with nitrites (bologna and broiled beef) can increase the risk of developing cancer.
The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign or symptom of this type of cancer? 1. Dysuria 2. Hematuria 3. Urgency on urination 4.Frequency of urination
Answer: 2. Hematuria Rationale: The most common sign in clients with cancer of the bladder is hematuria {PAINLESS Hematuria [early]; hematuria with dysuria [Later]}. The client also may experience irritative voiding symptoms such as frequency, urgency, and dysuria, and these symptoms often are associated with carcinoma in situ. Dysuria, urgency, and frequency of urination are also symptoms of a bladder infection.
A client is admitted to the hospital with suspected bladder cancer. The nurse assesses the client for which early signs and symptoms of the disease? 1. Proteinuria and dysuria 2. Hematuria and absence of pain 3. Painful urination and hematuria 4. Pyuria and palpable abdominal mass
Answer: 2. Hematuria and absence of pain Rationale: The most common earliest manifestation of bladder cancer is hematuria that is not accompanied by pain {PAINLESS Hematuria}. The hematuria is intermittent at first. Later signs and symptoms include hematuria with dysuria and frequency because of bladder irritation. Pyuria and proteinuria are not part of the clinical picture. A mass usually is not palpable.
The nurse is caring for a client with leukemia who is receiving intravenous chemotherapy. The nurse reviews the laboratory results and notes that the white blood cell count is 2000 mm3 (2 × 109/L), the platelet count is 150,000 mm3 (150 × 109/L), the clotting time is 10 minutes, and the ammonia level is 20 mcg/dL (12 mcmol/L). Which nursing action would be appropriate? 1. Place the client on bleeding precautions. 2. Place the client on neutropenic precautions. 3. Remove the rectal thermometer from the client's room. 4. Instruct the dietary department to eliminate all proteins from the client's diet.
Answer: 2. Place the client on neutropenic precautions. Rationale: The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). When the white blood cell count drops, neutropenic precautions need to be implemented. This includes protective isolation techniques to protect the client from infection. Bleeding precautions need to be initiated when the platelet count drops below 90,000 to 100,000 mm3 (90 to 100 × 109/L) or per health care provider prescription or agency policy. The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal clotting time is 8 to 15 minutes, and the normal ammonia level is 10 to 80 mcg/dL (6 to 47 mcmol/L). Removing the rectal thermometer from the client's room would be done if bleeding precautions were initiated. There is no useful reason to eliminate all protein from the diet.
The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse should prepare to implement which action based on this finding? 1. Remove the fresh flowers from the client's room. 2. Remove the rectal thermometer from the client's room. 3. Instruct family members to wear a mask when entering the client's room. 4. Call the dietary department to report that the client will be on a low-bacteria diet.
Answer: 2. Remove the rectal thermometer from the client's room. Rationale: When the client's platelet count is low, the client is at risk for bleeding. Options 1, 3, and 4 relate to the risk for infection. Rectal temperatures should not be taken on a client who is at risk for bleeding because the thermometer could cause an alteration in the delicate rectal membranes and lead to bleeding.
The nurse is preparing to care for a client with a diagnosis of metastatic cancer. The nurse notes documentation in the client's chart that the client is experiencing cachexia. Which should the nurse expect to note on assessment of the client? 1. Elevated blood pressure and ascites 2. Sunken eyes and a hollow cheek appearance 3. Periorbital edema and swelling around the ears 4. Generalized edema and the presence of weight gain
Answer: 2. Sunken eyes and a hollow cheek appearance Rationale: Cachexia accompanies chronic wasting diseases and conditions such as cancer, dehydration, and starvation. Assessment findings in a client with cachexia include sunken eyes; hollow cheeks; and an exhausted, defeated expression. Options 1, 3, and 4 are not characteristic of a cachectic appearance.
The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care? 1. "I change my pouch every week." 2. "I change the appliance in the morning." 3. "I empty the urinary collection bag when it is two-thirds full." 4. "When I'm in the shower I direct the flow of water away from my stoma."
Answer: 3. "I empty the urinary collection bag when it is two-thirds full." Rationale: The urinary collection bag should be changed when it is one-third full to prevent pulling of the appliance and leakage. The remaining options identify correct statements about the care of a urinary stoma.
The nurse is providing instructions to the client who is receiving external radiation therapy. Which statement, if made by the client, indicates the need for further instruction? 1. "I will dry affected areas with patting motions." 2. "I will wear soft clothing over the affected site." 3. "I will use a washcloth to wash the affected area." 4. "I need to make sure I carry my purse on the unaffected side."
Answer: 3. "I will use a washcloth to wash the affected area." Rationale: External radiation therapy requires that markings be placed on the skin so that therapy can be aimed at the affected areas. The hand rather than a washcloth should be used to wash the area to avoid irritation. The nurse should instruct the client who is undergoing external radiation therapy to dry affected areas with a patting (rather than rubbing) motion so as not to disrupt the markings on the skin. Soft clothing should be worn so that the affected area is not irritated. The client should be sure to carry her purse on the unaffected side.
As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? 1. "I should avoid blowing my nose." 2. "I may need a platelet transfusion if my platelet count is too low." 3. "I'm going to take aspirin for my headache as soon as I get home." 4. "I will count the number of pads and tampons I use when menstruating."
Answer: 3. "I'm going to take aspirin for my headache as soon as I get home." Rationale: During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells mm3 (20.0 × 109/L). The correct option describes an incorrect statement by the client. Aspirin and nonsteroidal antiinflammatory drugs and products that contain aspirin should be avoided because of their antiplatelet activity. Options 1, 2, and 4 are correct statements by the client to prevent and monitor bleeding.
The nurse conducted discharge teaching for the client diagnosed with melanoma. Which statement by a client indicates that education was effective? 1. "It is contagious." 2. "Metastasis is rare." 3. "It is highly metastatic." 4. "It is characterized by local invasion."
Answer: 3. "It is highly metastatic." Rationale: Melanomas are pigmented malignant lesions originating in the melanin-producing cells of the epidermis. This skin cancer is highly metastatic, and the affected person's survival depends on early diagnosis and treatment. It is not a contagious lesion. Basal cell carcinomas arise in the basal cell layer of the epidermis. Early malignant basal cell lesions often go unnoticed, and although metastasis is rare, underlying tissue destruction can progress to include vital structures. Squamous cell carcinomas are malignant neoplasms of the epidermis. They are characterized by local invasion and the potential for metastasis.
The client reports to the nurse that while performing testicular self-examination, he found a lump the size and shape of a pea. Which statement is the most appropriate response to the client? 1. "Lumps like that are normal. Don't worry." 2. "Let me know if it gets bigger next month." 3. "That's important to report even though it might not be serious." 4."That could be cancer. I'll ask the health care provider to examine you."
Answer: 3. "That's important to report even though it might not be serious." Rationale: Testicular cancer almost always occurs in only 1 testicle and is usually a pea-size, painless lump when discovered. The cancer is highly curable if found early. The finding should be reported to the health care provider.
The nurse is caring for a client undergoing external radiation. The client has developed a dry desquamation of the skin in the treatment area, and the nurse is teaching about management of the skin reaction. Which comment made by the client suggests understanding of the instructions? 1. "I don't need to stay out of the sun or put on sunscreen." 2. "I can use ice packs to relieve itching in the treatment area." 3. "When bathing I will use lukewarm water on the affected area." 4. "I can lubricate the irritated area with an ointment like bacitracin."
Answer: 3. "When bathing I will use lukewarm water on the affected area." Rationale: Radiation therapy causes skin cells to break down and die. This can cause a disruption in skin integrity. The client needs to use special and gentle skin care during treatment. This means washing with lukewarm water and not rubbing skin. The client will need to protect the skin from the sun even after radiation therapy is completed. The sun can burn the skin even on cloudy days or when the client is outside even for just a few minutes. The health care provider (HCP) may prescribe a high sun protection factor sunscreen. Care should be taken to not use extreme water temperatures, heating pads, ice packs, or other hot or cold items on the treatment area; these items can disrupt skin integrity. No products (creams, lotions, ointments, perfumes) should be used on the skin during radiation without approval of the HCP.
The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse include in discharge instructions? 1. Avoid driving the car for a few days. 2. Restrict fluid intake to prevent incontinence. 3. Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. 4.Notify the health care provider if small blood clots are noticed during urination.
Answer: 3. Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. Rationale: The client who has undergone a prostatectomy should avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. Driving a car and sitting for long periods are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Small pieces of tissue or blood clots may be passed during urination for up to 2 weeks after surgery; this is an expected occurrence.
The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse include in discharge instructions? 1. Avoid driving the car for a few days. 2. Restrict fluid intake to prevent incontinence. 3. Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. 4. Notify the health care provider if small blood clots are noticed during urination.
Answer: 3. Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. Rationale: The client who has undergone a prostatectomy should avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. Driving a car and sitting for long periods are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Small pieces of tissue or blood clots may be passed during urination for up to 2 weeks after surgery; this is an expected occurrence.
The nurse is caring for a client after intravesical instillation of an alkylating chemotherapeutic agent for the treatment of bladder cancer. What should the nurse instruct the client to do after the instillation? 1. Urinate immediately. 2. Maintain strict bed rest. 3. Change position every 15 minutes. 4.Retain the instillation fluid for 30 minutes.
Answer: 3. Change position every 15 minutes. Rationale: With intravesical instillation, normally the medication is injected into the bladder through a urethral catheter, the catheter is clamped or removed, and the client is asked to retain the fluid for 2 hours. The client changes position every 15 to 30 minutes, usually from side to side and from supine to prone. The client then voids and is instructed to drink water to flush the bladder.
The nurse is caring for a client after intravesical instillation of an alkylating chemotherapeutic agent for the treatment of bladder cancer. What should the nurse instruct the client to do after the instillation? 1. Urinate immediately. 2. Maintain strict bed rest. 3. Change position every 15 minutes. 4. Retain the instillation fluid for 30 minutes.
Answer: 3. Change position every 15 minutes. Rationale: With intravesical instillation, normally the medication is injected into the bladder through a urethral catheter, the catheter is clamped or removed, and the client is asked to retain the fluid for 2 hours. The client changes position every 15 to 30 minutes, usually from side to side and from supine to prone. The client then voids and is instructed to drink water to flush the bladder.
A community health nurse is providing an educational session on cancer of the cervix for women living in the community. The nurse informs the community residents that which is an early sign of this type of cancer? 1. Abdominal pain 2. Constant and profuse bleeding 3. Irregular vaginal bleeding or spotting 4. Dark and foul-smelling vaginal drainage
Answer: 3. Irregular vaginal bleeding or spotting Rationale: Early cancer of the cervix usually is asymptomatic. The 2 chief symptoms are leukorrhea (vaginal discharge) and irregular vaginal bleeding or spotting. The vaginal discharge increases gradually in amount and becomes watery and finally dark and foul-smelling because of necrosis and infection of the tumor mass. As the disease progresses, the bleeding may become constant and may increase in amount.
The nurse teaches skin care to a client receiving external radiation therapy. Which client statement indicates the need for further instruction? 1. "I will handle the area gently." 2. "I will wear loose-fitting clothing." 3. "I will avoid the use of deodorants." 4. "I will limit sun exposure to 1 hour daily."
Answer: 4. "I will limit sun exposure to 1 hour daily." Rationale: The client needs to be instructed to avoid exposure to the sun. Because of the risk of altered skin integrity, options 1, 2, and 3 are accurate measures in the care of a client receiving external radiation therapy.
The nurse is caring for a client with prostate cancer who is being treated with a hormone therapy. What should the nurse monitor for in order to evaluate the effect of this treatment? 1. An increase in testosterone levels 2. An increase in prostaglandin levels 3. An increase the amount of circulating androgens 4.A decline in the amount of circulating androgens
Answer: 4. A decline in the amount of circulating androgens Rationale: Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating androgens, because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms. The remaining options do not identify the goals of this form of treatment.
The nurse is caring for a client with prostate cancer who is being treated with a hormone therapy. What should the nurse monitor for in order to evaluate the effect of this treatment? 1. An increase in testosterone levels 2. An increase in prostaglandin levels 3. An increase the amount of circulating androgens 4. A decline in the amount of circulating androgens
Answer: 4. A decline in the amount of circulating androgens Rationale: Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating androgens, because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms. The remaining options do not identify the goals of this form of treatment.
During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease? 1. Diarrhea 2. Hypermenorrhea 3. Abnormal bleeding 4.Abdominal distention
Answer: 4. Abdominal distention Rationale: Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? 1. Fatigue 2. Weakness 3. Weight gain 4.Enlarged lymph nodes
Answer: 4. Enlarged lymph nodes Rationale: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.
The oncology nurse specialist provides an educational session for nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which is a characteristic of the disease? 1. Reed-Sternberg cells are present. 2. The lymph nodes, spleen, and liver are involved. 3. The prognosis depends on the stage of the disease. 4.The disease occurs most often in those older than 75 years of age.
Answer: 4. The disease occurs most often in those older than 75 years of age. Rationale: Hodgkin's lymphoma is a cancer that can occur at any age but appears to peak in 2 different age groups: in teens and young adults and in adults in their 50s and 60s. The remaining options are characteristics of this disease.
A client who is receiving chemotherapy for breast cancer develops myelosuppression. Which instructions should the nurse include in the client's discharge teaching plan? Select all that apply. 1. Avoid contact sports. 2. Wash hands frequently. 3. Increase intake of fresh fruits and vegetables. 4. Avoid crowded places such as shopping malls. 5. Treat a sore throat with over-the-counter products. 6.Avoid people who have received live attenuated vaccines.
Answers: 1. Avoid contact sports. 2. Wash hands frequently. 4. Avoid crowded places such as shopping malls. 6. Avoid people who have received live attenuated vaccines. Rationale: Effective measures should be used to protect the client from infection and bleeding. A variety of interventions are essential to keep the client who is receiving chemotherapy safe. Live attenuated vaccines can easily infect clients with myelosuppression, and crowded places usually have people who are sick and coughing and sneezing, which can easily cause illness in myelosuppressed clients. Contact sports can result in injury or bleeding, and hand washing is the mainstay of asepsis and protection from infection. The client with myelosuppression should not eat fresh fruits and vegetables because of the risk of contamination or infection. All foods should be thoroughly cooked. Option 5 is incorrect because many over-the-counter products contain acetaminophen or aspirin, which could potentially mask an elevated temperature. Additionally, aspirin is an antiplatelet and can cause bleeding. Clients receiving chemotherapy should not take any other medications without direction from the health care provider.
A client with bladder cancer has undergone surgical removal of the bladder with creation of an ileal conduit. Which assessment findings indicate that the client is developing complications? Select all that apply. 1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity 4. Urine output greater than 30 mL/hour 5.Mucus shreds in the urine collection bag
Answers: 1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity Rationale: To create an ileal conduit, the surgeon takes a short segment of the small intestine and reconnects the remaining intestine so that it functions normally. One end of the removed segment of intestine is placed at the skin surface to create the stoma. The stoma should be red and moist. A pale, dusky stoma indicates poor vascular supply that could result in necrosis. The stoma should be flush to the skin. The client should not have sharp abdominal pain with rigidity, an indication of peritonitis. Any of these findings should be reported to the health care provider. Options 4 and 5 are normal findings.
The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of Hodgkin's disease. Which assessment findings noted in the client's record are associated with this diagnosis? Select all that apply. 1. Fever 2. Weight loss 3. Night sweats 4. Visual changes 5. Enlarged, painless lymph nodes
Answers: 1. Fever 2. Weight loss 3. Night sweats 5. Enlarged, painless lymph nodes Rationale: Assessment of a client with Hodgkin's disease most often reveals enlarged, painless lymph nodes along with fever, malaise, and night sweats. Weight loss may be a feature in metastatic disease. Visual changes are not specifically associated with Hodgkin's disease.
The nurse is reviewing a plan of care for a client with cancer of the cervix who is undergoing treatment with a cesium (radiation) implant. Which nursing interventions are most appropriate for this client? Select all that apply. 1. Maintain the client on bed rest. 2. Place the client on a low-fiber diet. 3. Keep the head of the bed flat at all times. 4. Restrict visitors to visiting for 60 minutes per day. 5. Stand at the entrance of the room to communicate with the client when possible.
Answers: 1. Maintain the client on bed rest. 2. Place the client on a low-fiber diet. 5. Stand at the entrance of the room to communicate with the client when possible. Rationale: During application of the cesium implant, the client is on bed rest. The client may be logrolled from side to side, and the head of the bed may be raised to 45 degrees. The client is given a low-fiber diet to prevent frequent bowel movements, which is a side effect of the radiation. To minimize radiation exposure, the nurse stands at the head of the bed or at the entrance to the room. Visitors are limited to 30 minutes per day in the radiation area.
The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings should the nurse expect to note? Select all that apply. 1. Pathological fracture 2. Urinalysis positive for nitrites 3. Hemoglobin level of 15.5 g/dL (155 mmol/L) 4. Calcium level of 8.6 mg/dL (2.15 mmol/L) 5.Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L)
Answers: 1. Pathological fracture 2. Urinalysis positive for nitrites 5. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L) Rationale: Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. The client with malignant melanoma may experience pathologic fractures, hypercalcemia, anemia, recurrent infections, and renal failure. A serum calcium level of 8.6 mg/dL (2.15 mmol/L) and a hemoglobin level of 15.5 g/dL (155 mmol/L) are normal values. Therefore, the correct answers are pathological fractures, positive urinalysis for nitrites, and a serum creatinine level of 2.0 mg/dL (176.6 mcmol/L).
The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which are risk factors for cervical cancer? Select all that apply. 1. Smoking 2. Multiple sex partners 3. Human papillomavirus infection 4. Annual gynecological examinations 5.First intercourse before 17 years of age
Answers: 1. Smoking 2. Multiple sex partners 3. Human papillomavirus infection 5. First intercourse before 17 years of age Rationale: Risk factors for cervical cancer include human papillomavirus infection, active and passive cigarette smoking, and certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, and male partners with multiple sex partners). Screening via regular gynecological examinations and Papanicolaou (Pap) tests with treatment of precancerous abnormalities decreases the incidence and mortality of cervical cancer.
The nurse has conducted an educational session about risk factors for bladder cancer with clients in the ambulatory care center. Which statements by the clients indicate that teaching was effective? Select all that apply. 1. "Quitting smoking will help to reduce my risk." 2. "I have to consider natural alternatives to dye my hair." 3. "Infections of the bladder cannot cause bladder cancer." 4. "Chemicals have to enter the bladder directly in order to cause bladder cancer." 5."I have to consult with my health care provider about long-term use of cyclophosphamide medications."
Answers: 1."Quitting smoking will help to reduce my risk." 2."I have to consider natural alternatives to dye my hair." 5."I have to consult with my health care provider about long-term use of cyclophosphamide medications." Rationale: The greatest risk factor for bladder cancer is tobacco use. Exposure to toxins in hair dyes, rubber, paint, electric cable, and textile industries increases risk for bladder cancer. Chemicals may enter the body through contact with skin and mucous membranes in the respiratory tract. In addition, bladder infections and long-term use of cyclophosphamides may cause bladder cancer.
The nurse is reviewing the laboratory test results for a client receiving chemotherapy. The nurse notes that the white blood cell count is extremely low and places the client on neutropenic precautions. Which interventions are components of these types of precautions? Select all that apply. 1. Allowing only fresh fruits in the client's room 2. Removing fresh-cut flowers from the client's room 3. Encouraging the client to eat any types of fresh vegetables 4. Instructing family members on the proper technique for hand washing 5. Instructing family members to wear a mask when entering the client's room
Answers: 2. Removing fresh-cut flowers from the client's room 4. Instructing family members on the proper technique for hand washing 5. Instructing family members to wear a mask when entering the client's room Rationale: In the immunocompromised client, a low-bacteria diet is necessary. This includes avoiding the intake of fresh fruits and vegetables. Thorough cooking of all food also is required. Cut flowers and any standing water are removed from the room because both tend to harbor bacteria. Anyone who enters the client's room should perform strict and thorough hand washing and wear a mask.
The nurse is teaching a group of adults about the warning signs of cancer. Which signs and symptoms should the nurse mention to the group? Select all that apply. 1. Areas of alopecia 2. Sores that do not heal 3. Nagging cough or hoarseness 4. Indigestion or difficulty swallowing 5. Change in bowel or bladder habits 6.Absence or decreased frequency of menses
Answers: 2. Sores that do not heal 3. Nagging cough or hoarseness 4. Indigestion or difficulty swallowing 5. Change in bowel or bladder habits Rationale: Cancer is a neoplastic disorder that can involve all body systems. In cancer, cells lose their normal growth-controlling mechanism. Some signs and symptoms include sores that do not heal, a nagging cough or hoarseness, indigestion or difficulty swallowing, and a change in bowel or bladder habits. Areas of alopecia occur following cancer chemotherapy. Absence of menses is not a specific sign; however, abnormal occurrence of menses may be.
A client with laryngeal cancer has undergone laryngectomy and is now receiving external radiation therapy to the head and neck. The nurse should monitor the client for which side and adverse effects of external radiation? Select all that apply. 1. Cystitis 2. Stomatitis 3. Dysgeusia 4. Leukopenia 5. Xerostomia 6. Thrombocytopenia
Answers: 2. Stomatitis 3. Dysgeusia 5. Xerostomia Rationale: Stomatitis (inflammation of the mucous lining in the mouth), dysgeusia (distorted sense of taste), and xerostomia (dry mouth) are local effects of external radiation to the head and neck. Options 4 and 6 are systemic effects and would most likely occur if radiation were applied to areas around the bone marrow. Option 1 is unrelated to the client's condition.
Which interventions are the most appropriate for a client who is experiencing thrombocytopenia? Select all that apply. 1. Use a straight-edge razor for shaving. 2. Obtain a rectal temperature every 8 hours. 3. Check secretions for frank or occult blood. 4. Give vitamin K by the intramuscular route. 5. Encourage fluid intake to avoid constipation. 6.Provide oral sponges or a soft toothbrush for oral care.
Answers: 3. Check secretions for frank or occult blood. 5. Encourage fluid intake to avoid constipation. 6. Provide oral sponges or a soft toothbrush for oral care. Rationale: Thrombocytopenia is a condition in which the platelets fall below the number needed for normal coagulation. When a client has thrombocytopenia, the risk of bleeding is greatly increased. To monitor for bleeding, the nurse should check all secretions for frank or occult blood. Valsalva maneuvers (as in straining to have a stool, vomiting, or sneezing) could cause intracerebral bleeding when the platelet count is low. To avoid constipation, the nurse would encourage the client to take more fluids and increase his or her dietary fiber. The nurse should encourage the client to use a soft toothbrush or oral sponges to decrease irritation to the mouth and bleeding from the gums. An electric razor is recommended for shaving during times when the client is thrombocytopenic. The nurse should not take rectal temperatures or use any rectal suppositories because of the risk for injury to the rectal membranes with resultant bleeding. Medications should not be given subcutaneously or intramuscularly because use of these routes carries a risk for hemorrhage into the tissues.
The nurse has provided instructions to a client receiving external radiation therapy. Which client statement would indicate a need for further instruction regarding self-care related to the radiation therapy? 1. "I need to eat a high-protein diet." 2. "I need to avoid exposure to sunlight." 3. "I need to wash my skin with a mild soap and pat dry." 4. "I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding."
{Change to select all that apply} 4. "I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding." Rationale: The client should avoid pressure on the irritated area and should wear loose-fitting clothing. Specific health care provider instructions would be necessary if an alteration in skin integrity occurred as a result of the radiation therapy. Options 1, 2, and 3 are accurate measures to implement after radiation therapy.