MS2- Oncology- NCLEX Saunders

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

ANS 2, 3, 5 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.

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."

ANS: 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 community health nurse has conducted a teaching session for community members about the risk factors for laryngeal cancer. Which statement by a person attending the session indicates that teaching was effective? 1. "Exposure to airborne carcinogens can cause this type of cancer." 2. "Alcohol consumption is not associated with this type of cancer." 3. "Cigarette smoking does not contribute to the development of this type of cancer." 4. "Overuse of the voice is not associated with this type of cancer unless it causes spitting up of blood."

ANS: 1 "Exposure to airborne carcinogens can cause this type of cancer." Rationale: To decrease the risk of laryngeal cancer, the client should be instructed to avoid cigarette smoking, alcohol consumption, exposure to airborne carcinogens, and vocal abuse. The client is instructed to schedule routine physical examinations. The client also should be instructed to seek medical care if difficulty in swallowing, persistent hoarseness, enlarged lymph nodes in the neck, or unexplained weight loss occurs.

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."

ANS: 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."

ANS: 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 has provided teaching for an adult client about screening for a colon cancer. Which statement by the client indicates that education was effective? 1. "I should have an annual fecal occult blood test." 2. "I should have an annual colonoscopy when I become 60." 3. "I will have a colonoscopy before the fecal occult blood test." 4. "I will not need to have further fecal occult blood tests after a colonoscopy."

ANS: 1 "I should have an annual fecal occult blood test." Rationale: Fecal occult blood testing for colorectal cancer should be done annually for both men and women. Less invasive diagnostic testing such as a fecal occult blood test will be performed first. Colonoscopy is done at age 50 and then every 10 years.

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

ANS: 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 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

ANS: 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 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

ANS: 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

ANS: 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.

The nurse is reviewing the laboratory test results for a client with bladder cancer with bone metastasis. The nurse should contact the health care provider (HCP) if which finding is noted? 1. Calcium level of 15 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 200,000 mm3 4. White blood cell (WBC) count of 6000 mm3

ANS: 1 Calcium level of 15 mg/dL Rationale: Hypercalcemia is a serum calcium level greater than 10.5 mg/dL (2.6 mmol/L). It most often occurs in clients who have bone metastasis and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. Hypercalcemia is an oncological emergency, and the HCP needs to be notified. Options 2, 3, and 4 indicate normal laboratory values.

Capecitabine has been prescribed for a client, and the client asks the nurse about the side effects of the medication. The nurse responds that a frequent side effect of this medication is which finding? 1. Diarrhea 2. Weakness 3. Irritability 4. Increased appetite

ANS: 1 Diarrhea Rationale: Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Frequent side effects include diarrhea, nausea, vomiting, stomatitis, hand and foot syndrome (painful palmar-plantar erythema and swelling with paresthesias, tingling, and blistering), fatigue, anorexia, and dermatitis. Weakness, irritability, and increased appetite are not side effects of this medication.

A client admitted to the hospital is taking capecitabine. The nurse should monitor the client for which symptom that is a side or adverse effect of the medication? 1. Dyspnea 2. Dizziness 3. Headache 4. Constipation

ANS: 1 Dyspnea Rationale: Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Adverse effects include bone marrow depression, cardiovascular toxicity, and respiratory toxicity. Headache, constipation, and dizziness are not adverse effects of this medication.

A client is receiving intravesical chemotherapy for cancer of the bladder. The nurse should plan to take which action after the completion of each treatment? 1. Encourage increased intake of oral fluids. 2. Provide increased doses of opioid analgesics. 3. Place the client on strict contact isolation for 24 hours. 4. Keep the client on nothing by mouth (nil per os [NPO]) status for 6 hours.

ANS: 1 Encourage increased intake of oral fluids. Rationale: After intravesical chemotherapy, the nurse increases fluids to help flush the medication out of the bladder after the period of retention. The client does not have a need for opioid analgesics as a result of the chemotherapy treatment, nor does the client need to be NPO. The chemotherapy agent and the urine are treated as biohazards, but the client does not need to be placed on contact isolation.

A woman has just been told by the health care provider that she has breast cancer. The woman responds, "Oh, no! Does this mean I'm going to die?" The nurse interprets the woman's initial reaction as which response? 1. Fear 2. Rage 3. Denial 4. Anxiety

ANS: 1 Fear Rationale: The woman's reaction is one of fear. The woman has verbalized the object of fear (dying), which makes anxiety incorrect. There is no evidence of rage or denial in the woman's statement.

A client who has been diagnosed with cancer is to receive chemotherapy with both cisplatin and vincristine. The client asks the nurse why both medications must be given together. The nurse should explain to the client that the combination of 2 chemotherapeutic medications is used for which reason? 1. Increase the destruction of tumor cells. 2. Prevent the destruction of normal cells. 3. Decrease the risk of the alopecia and stomatitis. 4. Increase the likelihood of erythrocyte and leukocyte recovery.

ANS: 1 Increase the destruction of tumor cells. Rationale: Cisplatin is an alkylating-like medication, and vincristine is a vinca alkaloid. Alkylating medications are cell-cycle nonspecific. Vinca alkaloids are cell-cycle specific and act on the M phase. Single-agent medication therapy seldom is used. Combinations of medications are used to increase the destruction of tumor cells.

A client with squamous cell carcinoma is receiving bleomycin. What is the priority assessment of the nurse when monitoring for side and adverse effects of bleomycin? 1. Lung sounds 2. Platelet count 3. Blood pressure 4. White blood cell count

ANS: 1 Lung sounds Rationale: The major form of dose-limiting toxicity with bleomycin is injury to the lungs. It manifests initially as pneumonitis but can progress to severe pulmonary fibrosis and death. In addition to auscultation of lung sounds, pulmonary function studies should be monitored. Bleomycin is discontinued at the first sign of these adverse changes. Nausea and vomiting usually are mild with the use of this medication, and unlike most other anticancer agents, bleomycin exerts minimal toxicity to bone marrow. It does not directly affect the blood pressure.

The nurse transcribes a medication prescription for ifosfamide for a client with a diagnosis of germ cell cancer of the testes. The nurse reviews the client's history and looks for another prescription for which medication, which usually is administered with the antineoplastic medication? 1. Mesna 2. Melphalan 3. Prednisone 4. Blemomycin sulfate

ANS: 1 Mesna Rationale: Ifosfamide is used to treat refractory germ cell cancer of the testes. Concurrent therapy with mesna and at least 2 L of oral or intravenous fluid daily will limit the toxicity of this medication, evidenced by bone marrow depression and hemorrhagic cystitis. Mesna is a detoxifying agent used to inhibit the hemorrhagic cystitis induced by ifosfamide. The medications in options 2, 3, and 4 are not routinely administered with ifosfamide.

A client with liver cancer who is receiving chemotherapy tells the nurse that some foods taste bitter. The nurse would try to limit which food that is most likely to cause this bitter taste for the client? 1. Pork 2. Custard 3. Potatoes 4. Cantaloupe

ANS: 1 Pork Rationale: Chemotherapy may cause distortion of taste. Frequently, beef and pork are reported to taste bitter or rancid. The nurse can promote client nutrition by helping the client choose alternative sources of protein in the diet, such as mild-tasting fish, cold chicken, turkey, eggs, or cheese. Custard, potatoes, and cantaloupe are not likely to cause distortion of taste.

The nurse has provided discharge instructions to a client who underwent a right mastectomy with axillary lymph node dissection. Which statement made by the client indicates a need for further instruction regarding home care measures? 1. "It is all right to use a straight razor to shave under my arms." 2. "I must be sure to use thick potholders when I am cooking." 3. "I must be sure not to have blood pressures taken or blood drawn from my right arm." 4. "I should inform all of my other health care providers that I have had this surgical procedure."

ANS: 1 Rationale: After mastectomy with axillary lymph node dissection, the client is at risk for arm edema and infection. The client should be instructed regarding home care measures to prevent these complications. The client should be told to avoid activities such as carrying heavy objects or having blood pressure measurements taken on the affected arm. The client also should be instructed in the techniques to avoid trauma to the affected arm, such as using an electric razor to shave under the arms, using gloves when working in the garden, and using or wearing thick potholders when cooking.

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse contacts the health care provider before administering the medication if which disorder is documented in the client's history? 1. Pancreatitis 2. Diabetes mellitus 3. Myocardial infarction 4. Chronic obstructive pulmonary disease

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

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? 1. Age younger than 50 years 2. History of colorectal polyps 3. Family history of colorectal cancer 4. Chronic inflammatory bowel disease

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

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

ANS: 1 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 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

ANS: 1 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.

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

ANS: 1 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 home health care nurse is visiting a client who has undergone a mastectomy. The nurse determines that the client demonstrates greatest adjustment to the loss of the breast if which behavior is noted? 1. The client looks at the surgical site. 2. The client performs the prescribed arm exercises. 3. The client takes the pain medication as prescribed. 4. The client has read all of the postoperative materials provided by the hospital nurse.

ANS: 1 Rationale: Of the options provided, the client behavior in the correct option demonstrates the greatest adaptation or adjustment (looking at the surgical site). This indicates that the client has acknowledged and is beginning to cope with the loss of the breast. Reading postoperative care booklets and performing prescribed exercises indicate an interest in self-care and are positive signs indicating adjustment. Taking pain medication is not related to adjustment to the loss of the breast.

The nurse is teaching a client who has had a laryngectomy for laryngeal cancer how to use an artificial larynx. Which statement should the nurse include in the teaching? 1. "Hold the device alongside the neck." 2. "Insert the device into the tracheostomy." 3. "Swallow air into the esophagus to make speech." 4. "Hold the device over the upper portion of the sternum."

ANS: 1 Rationale: The artificial larynx is an electronic device that assists the client to produce speech after laryngectomy. There are 2 types: one is held at the side of the neck and the other is inserted into the mouth. The vibration produces a mechanical-sounding speech that is monotone in quality but intelligible. There is no need to insert the device into the tracheostomy or to hold the device over the sternum. Esophageal speech involves swallowing air, trapping it in the esophagus, and releasing it to create sound.

The nurse has admitted a client to the clinical nursing unit after undergoing a right mastectomy. The nurse should plan to place the right arm in which position? 1. Elevated on a pillow 2. Level with the right atrium 3. Dependent to the right atrium 4. Elevated above shoulder level

ANS: 1 Rationale: The client's operative arm should be positioned so that it is elevated on a pillow and not exceeding shoulder elevation. This position promotes optimal drainage from the limb, without impairing the circulation to the arm. If the arm is positioned flat (option 2) or dependent (option 3), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery.

The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy. The nurse should plan which measure to treat this complication? 1. Rinse the mouth with diluted baking soda or saline. 2. Use lemon and glycerin swabs liberally on painful oral lesions. 3. Brush the teeth and use non-waxed dental floss at least twice a day. 4. Place the client on NPO (nothing by mouth) status for 12 hours, and then resume liquids.

ANS: 1 Rinse the mouth with diluted baking soda or saline. Rationale: Stomatitis, or mouth ulcerations, occurs with the administration of many antineoplastic medications. The client's mouth should be examined daily for signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with baking soda or saline. Lemon and glycerin swabs may cause pain and further irritation. The client should avoid brushing the teeth and flossing when stomatitis is severe. Food and fluids are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet. Instruct the client to avoid spicy foods and foods with hard crusts or edges.

A female client with a diagnosis of breast cancer is taking cyclophosphamide. The client calls the health care clinic and tells the nurse that the medication is upsetting her stomach. Which instruction should the nurse provide to the client? 1. Take the medication with food. 2. Avoid drinking fluids while taking the medication. 3 .Try to take the medication with a small amount of orange juice. 4. Continue to take the medication on an empty stomach, and lie down after taking the medication.

ANS: 1 Take the medication with food. Rationale: Hemorrhagic cystitis is a toxic effect that can occur with the use of this medication. The medication should be taken on an empty stomach, but if the client complains of gastrointestinal (GI) upset, it can be taken with food. The client who is taking cyclophosphamide needs to be instructed to drink copious amounts of fluids during the administration of this medication. Orange juice probably would cause and increase the GI upset. Option 4 will not assist in relieving the discomfort experienced by the client.

A client with testicular cancer is receiving cisplatin. The nurse assesses for which finding as a toxic effect of this medication? 1. Tinnitus 2. Diarrhea 3. Nausea and vomiting 4. Elevated white blood cell (WBC) count

ANS: 1 Tinnitus Rationale: Cisplatin is a medication that kills cells primarily by forming cross-links between and within strands of deoxyribonucleic acid (DNA). Its principal use is in the treatment of testicular cancer, although it also can be used to treat carcinomas of the ovary, bladder, head, and neck. It can cause neurotoxicity, nephrotoxicity, bone marrow depression, and ototoxicity, which manifests as tinnitus and high-frequency hearing loss. Nausea and vomiting are expected side effects, which can be severe and begin 1 hour after administration, persisting for 1 to 2 days. Diarrhea is not an associated side effect or toxic effect.

The client is preparing for discharge from the hospital after radical vulvectomy. The nurse should include which activity as appropriate for the client immediately after discharge? 1. Walking 2. Driving a car 3. Sexual activity 4. Sitting for lengthy periods

ANS: 1 Walking Rationale: The client should resume activity slowly, but walking is a beneficial activity. The client should know to rest when fatigued. Sexual activity is prohibited for 4 to 6 weeks after surgery. Activities to be avoided include driving, heavy housework, wearing tight clothing, crossing the legs, and prolonged standing or sitting.

A client with cancer is about to be started on mitomycin. The nurse should contact the health care provider after noting that the client is also taking which medication? 1. Warfarin 2. Furosemide 3. Allopurinol 4. Ondansetron

ANS: 1 Warfarin Rationale: Mitomycin is an antitumor antibiotic. The use of aspirin, anticoagulants, and thrombolytic agents should be avoided concurrently with this medication because mitomycin causes thrombocytopenia. Warfarin is an anticoagulant, and the risk of bleeding is increased if administered during mitomycin therapy. Furosemide is a diuretic and is not related to the question. Allopurinol is an antigout medication, which prevents or treats hyperuricemia resulting from blood dyscrasias caused by cancer chemotherapy. Ondansetron is an antiemetic used to prevent or treat nausea and vomiting during chemotherapy.

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

ANS: 1, 2, 3 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 caring for a client who has undergone a radical neck dissection and creation of a tracheostomy because of laryngeal cancer and is providing discharge instructions to the client. Which should be included in the instructions? Select all that apply. 1. Protect the stoma from water. 2. Use a humidifier if dryness is a problem. 3. Keep powders and sprays away from the stoma site. 4. Use an air conditioner to provide cool air to assist in breathing. 5. Apply a thin layer of non-oil-based ointment to the skin around the stoma to prevent cracking.

ANS: 1, 2, 3, 5 Rationale: Air conditioners should be avoided to prevent excessive coldness. The remaining options are appropriate interventions regarding stoma care after radical neck dissection and creation of a tracheotomy.

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

ANS: 1, 2, 3, 5 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 monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? Select all that apply. 1. Stop the infusion. 2. Notify the health care provider (HCP). 3. Prepare to apply ice or heat to the site. 4. Restart the IV at a distal part of the same vein. 5. Prepare to administer a prescribed antidote into the site. 6. Increase the flow rate of the solution to flush the skin and subcutaneous tissue.

ANS: 1, 2, 3, 5 Rationale: Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the IV administration of an antineoplastic medication, the infusion is stopped and the HCP is notified. Ice or heat may be prescribed for application to the site and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein.

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

ANS: 1, 2, 3, 5 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.

A client who is receiving chemotherapy for breast cancer develops myelosupprerssion. 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.

ANS: 1, 2, 4, 6 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.

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.

ANS: 1, 2, 5 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)

ANS: 1, 2, 5 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 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."

ANS: 1, 2, 5 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.

A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? Select all that apply. 1. Radiation 2. Chemotherapy 3. Increased fluid intake 4. Decreased oral sodium intake 5. Serum sodium level determination 6. Medication that is antagonistic to antidiuretic hormone

ANS: 1, 2, 5, 6 Rationale: Cancer is a common cause of SIADH. In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

A client with a medical diagnosis of breast cancer is undergoing chemotherapy. The client complains to the nurse about losing her hair and severe fatigue from the treatment. Which interventions should the nurse implement for this client? Select all that apply. 1. Review side effects of chemotherapy and treatment with the client. 2. Teach the client how to resolve specific concerns of her personal life. 3. Teach the client to pace activities with rest so as to maintain strength. 4. Offer information on available counseling services and support groups. 5. Tell the client about some other clients who have had breast cancer treatment. 6. Inquire how the cancer diagnosis and treatment affect the client's normal routine.

ANS: 1, 3, 4, 6 Rationale: It is not therapeutic nor is it the nurse's role to teach the client how to resolve specific concerns of her personal life. The nurse should determine how the cancer diagnosis and treatment are affecting the client's normal routine, and the client should be aware of potential side effects of treatment so as to cope with the events with medications or other measures. It is important for the nurse to inform clients about support groups available (i.e., Reach for Recovery) so the client does not feel isolated. Teaching clients to pace activities even when they feel well will conserve energy so they ultimately feel stronger and less fatigued. It is a breach of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA) laws for the nurse to discuss other clients and their medical problems.

The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply. 1. Facial edema in the morning 2. Weight loss of 20 lb (9 kg) in 1 month 3. Serum calcium level of 12 mg/dL (3.0 mmol/L) 4. Serum sodium level of 136 mg/dL (136 mmol/L) 5. Serum potassium level of 3.4 mg/dL (3.4 mmol/L) 6. Numbness and tingling of the lower extremities

ANS: 1, 3, 6 Rationale: Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12 mg/dL (3.0 mmol/L) indicates hypercalcemia. Numbness and tingling of the lower extremities could be a sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium level of 136 mg/dL (136 mmol/L) is a normal level.

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."

ANS: 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."

ANS: 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.

Capecitabine has been prescribed, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further instruction? 1. "I need to monitor my temperature." 2. "I need to be sure to go to the clinic to receive my yearly flu vaccine." 3. "I may have some diarrhea, but if it becomes severe, I will call my health care provider." 4. "It's important for me to contact my health care provider if I have any fever or other signs of infection."

ANS: 2 "I need to be sure to go to the clinic to receive my yearly flu vaccine." Rationale: Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Adverse effects include bone marrow depression, cardiovascular toxicity, and respiratory toxicity. The client is instructed to obtain health care provider (HCP) approval before receiving immunizations because the medication lowers the body's resistance to infection. Diarrhea is a frequent side effect of this medication, but the client should contact the HCP if it becomes severe. The client should monitor his or her temperature and call the HCP for severe diarrhea or for a fever or other sign of infection.

A client with lung cancer is receiving a high dose of methotrexate. A health care provider also prescribes leucovorin to the client. The nurse should explain to the client that leucovorin is prescribed for which reason? 1. "It promotes DNA synthesis." 2. "It helps to preserve normal cells." 3. "It promotes excretion of the medication." 4. "It facilitates the synthesis of nucleic acids."

ANS: 2 "It helps to preserve normal cells." Rationale: High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given; this is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Note that leucovorin rescue is potentially hazardous. Failure to administer leucovorin in the right dose at the right time can be fatal.

The nurse is reviewing the preoperative prescriptions for a client with a colon tumor who is scheduled for abdominal perineal resection and notes that the health care provider has prescribed neomycin for the client. After discussing a prescription for neomycin with the nursing student who is caring for the client, the nurse determines that the student understands the rationale for administration if which statement is made? 1. "The client is allergic to penicillin." 2. "It will help to decrease the bacteria in the bowel." 3. "It is given to prevent an immune dysfunction postoperatively." 4. "It is given because the client has an infection that must be treated prior to surgery."

ANS: 2 "It will help to decrease the bacteria in the bowel." Rationale: To reduce the risk of contamination at the time of surgery, the surgeon may prescribe that the bowel is emptied and cleansed. Laxatives and enemas may be prescribed to empty the bowel. An intestinal anti-infective such as neomycin may also be prescribed to decrease the bacteria in the bowel. There are no data in the question that indicate that the client has an infection or is allergic to penicillin. The medication does not prevent immune dysfunction.

Which statement made by a client who will undergo cytoreductive (debulking) surgery for ovarian cancer indicates that teaching by the nurse was effective? 1. "The surgery will remove precancerous tissue." 2. "The surgery will help to reduce the size of the tumor." 3. "The surgery will cure the cancer by removing all gross and microscopic tumor cells." 4. "The surgery is focused at improving the appearance of the previously treated body part."

ANS: 2 "The surgery will help to reduce the size of the tumor." Rationale: Cytoreductive or debulking surgery may be used if a large tumor cannot be removed completely, as is often the case with late-stage ovarian cancer (e.g., the tumor is attached to a vital organ or has spread throughout the abdomen). When this occurs, as much tumor as possible is removed, and adjuvant chemotherapy or radiation may be prescribed. Therefore, the remaining options are incorrect purposes for cytoreductive surgery.

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

ANS: 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

ANS: 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.

A 27-year-old client is undergoing evaluation of lumps in her breasts. In determining whether the client could have fibrocystic breast disorder, the nurse should ask her whether the breast lumps seem to become more prominent or troublesome at which time? 1. After menses 2. Before menses 3. During menses 4. At any time, regardless of the menstrual cycle

ANS: 2 Before menses Rationale: The nurse assesses the client with fibrocystic breast disorder for worsening of symptoms (breast lumps, painful breasts, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormone changes. Therefore, the other options are incorrect.

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

ANS: 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

ANS: 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 admitting a client with laryngeal cancer to the nursing unit. What should the nurse assess for as the most common risk factor for this type of cancer? 1. Alcohol abuse 2. Cigarette smoking 3. Use of chewing tobacco 4. Exposure to air pollutants

ANS: 2 Cigarette smoking Rationale: The most common risk factor associated with laryngeal cancer is cigarette smoking. Heavy alcohol use and the combined use of alcohol and tobacco increase the risk. Another risk factor is exposure to environmental pollutants.

For the client with stomatitis resulting from chemotherapy, the care plan should include which intervention? 1. Inspect the mouth every week for fungus. 2. Encourage foods with neutral or cool temperatures. 3. Give the client spicy foods to stimulate the sense of taste. 4. Perform frequent oral hygiene using a commercial alcohol-based mouthwash.

ANS: 2 Encourage foods with neutral or cool temperatures. Rationale: Stomatitis is inflammation of the oral cavity, and using commercial mouthwashes containing alcohol or encouraging spicy foods will cause pain. Foods are better tolerated by the client with stomatitis when the food is cool or of neutral temperature. It is important to monitor for oral fungal infections, but this assessment should be completed at least daily.

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

ANS: 2 Hematuria and absence of pain Rationale: The most common earliest manifestation of bladder cancer is hematuria that is not accompanied by pain. 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 client with breast cancer has been given a prescription for cyclophosphamide. The nurse determines that the client understands the proper use of the medication if the client states to take which measure? 1. Increase dietary intake of potassium. 2. Increase fluid intake to 2 to 3 L/day. 3. Take the medication with large meals. 4. Decrease dietary intake of magnesium.

ANS: 2 Increase fluid intake to 2 to 3 L/day. Rationale: An adverse effect of cyclophosphamide is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication. Clients also should observe for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake.

Capecitabine has been prescribed for a client, and the client asks the nurse about the action of the medication. The nurse formulates a response based on which mechanism of action of this medication? 1. Promotes DNA synthesis 2. Interferes with protein synthesis 3. Assists with the processing of RNA 4. Processes enzymes needed for cellular growth

ANS: 2 Interferes with protein synthesis Rationale: Capecitabine is an antimetabolite that inhibits enzymes necessary for the synthesis of essential cellular components. It interferes with DNA synthesis, RNA processing, and protein synthesis. Capecitabine does not promote DNA synthesis, assist with the processing of RNA, or process enzymes needed for cellular growth.

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.

ANS: 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 should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which result was reported from the laboratory? 1. Clotting time 12 seconds 2. Platelet count 50,000 mm3 3. Ammonia level 28 mcg/dL 4. White blood cell count (WBC) 4500 mm3

ANS: 2 Platelet count 50,000 mm3 Rationale: Platelets are the building blocks of blood clots. The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). Bleeding precautions should be instituted when the platelet count drops to a low level, as defined by agency policy. Bleeding precautions include avoiding all trauma, such as rectal temperatures or injections. The normal clotting time is 8 to 15 seconds. The normal ammonia value is 10 to 80 mcg/dL (6 to 47 mcmol/L). The normal WBC count is 5000 to 10,000 mm3 (5 to 10 × 109/L). When the WBC count drops, neutropenic precautions should be implemented.

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition? 1. Rupture of the bladder 2. The development of a vesicovaginal fistula 3. Extreme stress caused by the diagnosis of cancer 4. Altered perineal sensation as a side effect of radiation therapy

ANS: 2 Rationale: A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client's complaint is not associated with options 1, 3, or 4.

A client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level

ANS: 2 Rationale: Busulfan can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Options 1, 3, and 4 are not specifically related to this medication.

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1. Placing cool compresses on the affected arm 2. Elevating the affected arm on a pillow above her heart level 3. Avoiding arm exercises in the immediate postoperative period 4. Maintaining an intravenous site below the antecubital area on the affected side.

ANS: 2 Rationale: Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

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

The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? 1. Clamp the surgical drain. 2. Change the dressing as prescribed. 3. Notify the health care provider (HCP). 4. Remove and replace the perineal packing.

ANS: 2 Rationale: Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected. Therefore, the nurse should change the dressing as prescribed. A surgical drain should not be clamped because this action will cause the accumulation of drainage within the tissue. The nurse does not need to notify the HCP at this time. Drains and packing are removed gradually over a period of 5 to 7 days as prescribed. The nurse should not remove the perineal packing.

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

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

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 on urination

ANS: 2 Rationale: The most common sign in clients with cancer of the bladder is hematuria. 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.

The ambulatory care nurse is providing discharge instructions to a female client who underwent cryosurgery with laser therapy because of a positive Papanicolaou test. Which statement by the client indicates an understanding of the instructions? 1. "I should take sitz baths every 4 hours for the next week." 2. "I should expect the vaginal discharge to be clear and watery." 3. "Very strong pain medications will be needed to relieve any discomfort I may have." 4. "If I note any odor to the vaginal discharge, I should call the health care provider immediately."

ANS: 2 Rationale: Vaginal discharge should be clear and watery after cryosurgery with laser therapy. The client should be told that the vaginal discharge may be odorous as a result of the sloughing of dead cell debris. This vaginal odor takes about 8 weeks to resolve. The client should be instructed to avoid any sitz baths or tub baths while the area is healing, which takes approximately 10 weeks. Pain is mild after this procedure, and very strong pain medication will not be needed.

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.

ANS: 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

ANS: 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.

A client has undergone abdominal perineal resection for a bowel tumor. The nurse interprets that the client's colostomy is beginning to function if which sign is noted? 1. Absent bowel sounds 2. The passage of flatus 3. Blood drainage from the colostomy 4. The client's ability to tolerate food

ANS: 2 The passage of flatus Rationale: Following abdominal perineal resection, a colostomy should begin to function within 72 hours after surgery, although it may take up to 5 days. The nurse should monitor for a return of peristalsis by listening for bowel sounds and checking for the passage of flatus. Absent bowel sounds indicate that peristalsis has not returned. The client would remain NPO (nothing by mouth) until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from a colostomy.

The community health nurse is preparing an educational session for a group of women and will be discussing the primary prevention strategies and treatment measures for breast cancer. What information should the nurse include in the educational session? 1. Older women are more likely to get mammograms. 2. Treatment decisions are based on a woman's overall health. 3. Women younger than age 65 are more likely to get breast cancer. 4. A woman's age is the main factor used to decide which screening methods to use.

ANS: 2 Treatment decisions are based on a woman's overall health. Rationale: Breast cancer occurs most often in women who are 65 years of age or older, and older women are less likely to have mammograms. Rather than using the woman's age to decide on screening and treatment measures, the woman's overall health is used to make these determinations, since health status has a greater influence on tolerance to treatment.

The nurse is providing discharge instructions to a client who has undergone treatment of cervical cancer with a radiation (cesium) implant. Which instruction should the nurse provide to the client? 1. Avoid douching for at least 1 year. 2. Use a vaginal dilator 3 times a week. 3. Sexual activity can be resumed in about 2 months. 4. Bed rest is recommended for at least 1 week after discharge.

ANS: 2 Use a vaginal dilator 3 times a week. Rationale: Radiation causes scarring and fibrosis of the vagina, with a decrease in normal vaginal secretions. The client is instructed to use a vaginal dilator to prevent vaginal narrowing and stenosis. A vaginal discharge often occurs, and the woman may need to douche twice daily for as long as the discharge and odor persist. Sexual activity after internal radiation treatment can be resumed in about 3 weeks. Bed rest is not required.

A client is diagnosed as having a bowel tumor. The nurse should monitor the client for which complications of this type of tumor? Select all that apply. 1. Flatulence 2. Peritonitis 3. Hemorrhage 4. Fistula formation 5. Bowel perforation 6. Lactose intolerance

ANS: 2, 3, 4, 5 Rationale: Complications of bowel tumors include bowel perforation, which can result in hemorrhage and peritonitis. Other complications include bowel obstruction and fistula formation. Flatulence can occur but is not a complication; lactose intolerance also is not a complication of intestinal tumor.

The nurse should include which intervention in the care of a client who has undergone a vaginal hysterectomy for the treatment of cancer? Select all that apply. 1. Elevate the knee gatch on the bed. 2. Encourage ambulation as prescribed. 3. Remove antiembolism stockings twice daily. 4. Assist with range-of-motion (ROM) leg exercises. 5. Check placement of pneumatic compression boots.

ANS: 2, 3, 4, 5 Rationale: The client is at risk for deep vein thrombosis (DVT) or thrombophlebitis after this surgery, as with any other major surgery. The nurse should avoid using the knee gatch in the bed because doing so inhibits venous return, thus placing the client at greater risk for DVT or thrombophlebitis. The nurse will implement measures that prevent DVT or thrombophlebitis; ROM exercises, ambulation, antiembolism stockings, and pneumatic compression boots are all helpful.

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

ANS: 2, 3, 4, 5 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.

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

ANS: 2, 4, 5 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.

A client is having a diagnostic workup for colorectal cancer. Which factors in the client's history place the client at increased risk for this type of cancer? Select all that apply. 1. A high-fiber diet 2. A diet high in fats 3. Minimal alcohol intake 4. A diet high in carbohydrates 5. A history of inflammatory bowel disease 6. A maternal grandfather who had a history of heart disease

ANS: 2, 4, 5 Rationale: A high-fiber diet actually lessens the chances of developing colorectal cancer. This type of cancer most often occurs in populations with diets low in fiber and high in refined carbohydrates, fats, and meats. Other risk factors include a family history of the disease, rectal polyps, and active inflammatory disease of at least 10 years' duration.

The community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster? Select all that apply. 1. Multiparity 2. Early menarche 3. Early menopause 4. Family history of breast cancer 5. High-dose radiation exposure to chest 6. Previous cancer of the breast, uterus, or ovaries

ANS: 2, 4, 5, 6 Rationale: Risk factors for breast cancer include nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries. In addition, specific inherited mutations in BReast CAncer (BRCA)1 and BRCA2 increase the risk of female breast cancer; these mutations are also associated with an increased risk for ovarian cancer.

The nurse is preparing a list of home care instructions regarding stoma and laryngectomy care for a client with laryngeal cancer who had a laryngectomy. Which instructions should be included in the list? Select all that apply. 1. Restrict fluid intake. 2. Obtain a MedicAlert bracelet. 3. Keep the humidity in the home low. 4. Prevent debris from entering the stoma. 5. Avoid exposure to people with infections. 6. Avoid swimming and use care when showering.

ANS: 2, 4, 5, 6 Rationale: The nurse should teach the client how to care for the stoma, depending on the type of laryngectomy performed. Most interventions focus on protection of the stoma and the prevention of infection. Interventions include obtaining a MedicAlert bracelet, preventing debris from entering the stoma, avoiding exposure to people with infections, and avoiding swimming and using care when showering. Additional interventions include wearing a stoma guard or high-collared clothing to protect the stoma, increasing the humidity in the home, and increasing fluid intake to 3000 mL/day to keep the secretions thin.

A client calls the ambulatory care clinic and tells the nurse that she found an area that looks like the peel of an orange when performing breast self-examination (BSE) but found no other changes. What is the nurse's best response to this client? 1. "Good job performing your BSE. I am sure that is nothing to be concerned about." 2. "Make sure you tell the health care provider about your finding at the next regularly scheduled visit." 3. "I am glad you called to report this finding. Can you come to the clinic to see your health care provider tomorrow?" 4. "Do you have a thermometer? You need to take your temperature and call back if you have a fever over 101°F/38.3°C."

ANS: 3 "I am glad you called to report this finding. Can you come to the clinic to see your health care provider tomorrow?" Rationale: Peau d'orange or orange peel appearance of the skin over the breast is associated with late breast cancer. Therefore, the nurse would arrange for the client to come to the clinic as soon as possible. Peau d'orange is not indicative of an infection.

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."

ANS: 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 nurse is reviewing medical record notes of a client with bladder cancer who is prescribed concentrations of methotrexate followed by leucovorin (citrovorum factor, folic acid). The nurse should include in the client's education which information about the anticipated therapeutic effect of leucovorin? 1. "It promotes medication excretion." 2. "It will promote protein synthesis." 3. "It will help to preserve normal cells." 4. "It speeds up the effect of the methotrexate."

ANS: 3 "It will help to preserve normal cells." Rationale: The administration of leucovorin with methotrexate is known as leucovorin rescue. High concentrations of methotrexate cause harm and damage to normal cells. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Leucovorin rescue is potentially hazardous because failure to administer leucovorin in the right dose at the right time can be fatal.

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."

ANS: 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."

ANS: 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.

ANS: 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 chemotherapy client with a low platelet aggregation level. Which likely caused this decreased platelet production? 1. Anemia 2. Thrombocytopenia 3. Bone marrow suppression 4. Low hemoglobin and hematocrit (H&H) counts

ANS: 3 Bone marrow suppression Rationale: Suppression of bone marrow function is a result of many chemotherapy medications leading to inhibition of platelet production. Because of bone marrow suppression, chemotherapy clients are at risk of bruising and bleeding, and these risks are increased by medications that inhibit platelet function, such as most conventional nonsteroidal antiinflammatory drugs (NSAIDs). Aspirin is especially dangerous because it causes irreversible inhibition of platelet aggregation. The other options are incorrect.

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.

ANS: 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

ANS: 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.

A client seeks treatment in an ambulatory clinic for a complaint of hoarseness that has lasted for 6 weeks. On the basis of this symptom, the nurse should consider developing a plan of care for which possible medical diagnosis? 1. Thyroid cancer 2. Acute laryngitis 3. Laryngeal cancer 4. Bronchogenic cancer

ANS: 3 Laryngeal cancer Rationale: Hoarseness is a common early sign of laryngeal cancer but not of bronchogenic or thyroid cancer. Hoarseness that lasts for 6 weeks is not associated with an acute problem, such as laryngitis.

The nurse is caring for a client with metastatic breast cancer. The client describes a new and sudden sharp pain in the back. Based on this assessment finding, which is the priority nursing intervention? 1. Document the findings. 2. Administer pain medication. 3. Notify the health care provider (HCP). 4. Place a heating pad on the client's back.

ANS: 3 Notify the health care provider (HCP). Rationale: Spinal cord compression should be suspected in a client with metastatic disease, particularly with sudden onset of new back pain. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression constitutes an oncological emergency, so the HCP should be notified. Although the nurse would document this finding, this is not the priority action. The nurse would not administer pain medication or place a heating pad on the client unless the cause of the new pain has been determined. In addition, a prescription from the HCP is needed for the use of a heating pad.

The nurse monitoring an oncological client assesses for which early sign of vena cava syndrome? 1. Cyanosis 2. Arm edema 3. Periorbital edema 4. Mental status change

ANS: 3 Periorbital edema Rationale: Vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs.

The nurse is monitoring a client with acute lymphocytic leukemia for toxic effects of asparaginase. The nurse should notify the health care provider if monitoring reveals which finding? 1. Alopecia 2. Oral ulcerations 3. Prolonged blood clotting times 4. Decreased white blood cell count

ANS: 3 Prolonged blood clotting times Rationale: Asparaginase can cause severe adverse effects; however, they often are different from those of other antineoplastic medications. By inhibiting protein synthesis, the medication can cause coagulation deficiencies and injury to the liver, pancreas, and kidneys. Signs and symptoms of central nervous system depression ranging from confusion to coma can occur. Nausea and vomiting can be intense and may limit the dose that can be tolerated. In contrast with most antineoplastic medications, asparaginase does not depress the bone marrow, nor does it cause alopecia, oral ulceration, or intestinal ulceration.

A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? 1. "You can take aspirin as needed for headache." 2. "You can drink beverages containing alcohol in moderate amounts each evening." 3. "You need to consult with the health care provider (HCP) before receiving immunizations." 4. "It is fine to receive a flu vaccine at the local health fair without HCP approval because the flu is so contagious."

ANS: 3 Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.

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."

ANS: 3 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 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."

ANS: 3 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.

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count

ANS: 3 Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? 1. Cyanosis 2. Arm edema 3. Periorbital edema 4. Mental status changes

ANS: 3 Rationale: Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental status changes are late signs.

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? 1. "This medication can be used only to treat breast cancer." 2. "Yes, your family member can take this medication for bladder cancer as well." 3. "This medication can be taken to prevent and treat clients with breast cancer." 4. "This medication can be taken by anyone with cancer as long as their health care provider approves it."

ANS: 3 Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk.

The home health care nurse is providing instructions to a client after a vulvectomy. Which instruction should the nurse provide to the client? 1. "You can engage in sexual activity in 2 weeks." 2. "It is all right to begin to drive a car as long as you do not drive long distances." 3. "Resume activities slowly, keeping in mind that walking is a beneficial activity." 4. "It is important to rest and sit in a chair with your legs elevated as much as possible."

ANS: 3 Rationale: The client should resume activities slowly, and walking is a beneficial activity. Sexual activity is prohibited for approximately 4 to 6 weeks after surgery. Activities to be avoided include driving, heavy housework, wearing tight clothing, crossing the legs, and prolonged sitting and standing. The client should not be instructed to sit in a chair as much as possible because pressure on the surgical site could lead to complications related to the surgery.

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."

ANS: 3 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.

Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to perform which assessment before administering chemotherapy? 1. Measure the client's abdominal girth. 2. Calculate the client's body mass index. 3. Measure the client's current weight and height. 4. Ask the client about his or her weight and height.

ANS: 3 Rationale: To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total BSA, which requires a current accurate height and weight for BSA calculation (before each medication administration). Asking the client about his or her height and weight may lead to inaccuracies in determining a true BSA and dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed.

The clinic nurse prepares instructions for a client who developed stomatitis after the administration of a course of antineoplastic medications. The nurse should provide the client with which instruction? 1. Avoid foods and fluids for the next 12 to 24 hours. 2. Swab the mouth with lemon and glycerin 4 times a day. 3. Rinse the mouth with a diluted solution of baking soda or saline. 4. Brush the teeth with a stiff-bristled toothbrush, and use dental floss 3 times a day.

ANS: 3 Rinse the mouth with a diluted solution of baking soda or saline. Rationale: Stomatitis (ulceration in the mouth) can result from the administration of antineoplastic medications. The client should be instructed to examine the mouth daily and report any signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with a diluted solution of baking soda or saline. Food and fluid are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet that includes milkshakes and ice cream. Instruct the client to avoid spicy foods and foods with hard crusts or edges. Lemon and glycerin swabs may cause pain and further irritation. The client should avoid brushing the teeth, particularly with a stiff-bristled toothbrush, and flossing when stomatitis is severe.

A client is receiving external radiation to the neck for cancer of the larynx. Which is the most likely expected effect? 1. Dyspnea 2. Diarrhea 3. Sore throat 4. Constipation

ANS: 3 Sore throat Rationale: In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat. Dyspnea may occur with lung involvement. Diarrhea and constipation may occur with radiation to the gastrointestinal tract.

A client with cancer has received a course of chemotherapy with fluorouracil. The nurse should tell the client to report which finding immediately? 1. Alopecia 2. Headache 3. Stomatitis and diarrhea 4. Changes in color vision

ANS: 3 Stomatitis and diarrhea Rationale: Fluorouracil should be discontinued as soon as reactions (stomatitis, diarrhea) occur. Dosage can also be limited by palmar-plantar erythrodysesthesia syndrome (also called hand-foot syndrome), characterized by tingling, burning, redness, flaking, swelling, and blistering of the palms and soles. Alopecia is common and would not require immediate reporting. Headache and vision changes are not associated with fluorouracil.

The nurse in the health care provider's office is performing a postoperative assessment of a client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should provide which information to the client about her complaint? 1. These sensations are signs of a complication. 2. These sensations probably will be permanent. 3. These sensations dissipate over several months and usually resolve after 1 year. 4. It is nothing to worry about because most women who have this type of surgery experience this problem.

ANS: 3 These sensations dissipate over several months and usually resolve after 1 year. Rationale: Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow occurs in most women after mastectomy. It is a result of injury to the nerves that provide sensation to the skin in those areas. These sensations may be described as heaviness, pain, tingling, burning, or "pins and needles." These sensations dissipate over several months and usually resolve by 1 year after surgery. These sensations are not a sign of a complication and are not permanent. The nurse would not tell the client that a complaint is nothing to worry about because this is nontherapeutic and avoids the client's concern.

A health care provider prescribes cisplatin and vincristine to a client with bladder cancer. The nurse should explain to the client that 2 medications are administered together for which reason? 1. To prevent alopecia 2. To decrease the destruction of cells 3. To increase the therapeutic response 4. To prevent gastrointestinal side effects

ANS: 3 To increase the therapeutic response Rationale: Cisplatin is an alkylating type of medication, and vincristine is a vinca (plant) alkaloid. Alkylating medications are cell-cycle nonspecific. Vinca alkaloids are cell-cycle specific and act on the M phase. Combinations of medications are used to enhance tumoricidal effects and increase the therapeutic response. Alopecia and gastrointestinal disturbances are side and adverse effects of chemotherapy.

The nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. The nurse should teach the client to put the pillow in which location for self-examination of the right breast? 1. Under the left scapula 2. Under the left shoulder 3. Under the right shoulder 4. Under the small of the back

ANS: 3 Under the right shoulder Rationale: The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder, and vice versa. Therefore, options 1, 2, and 4 are incorrect.

The nurse is preparing a plan of care for a client who will be receiving intravenous mitomycin for the treatment of cancer. In developing the plan of care, the nurse includes monitoring which as the priority? 1. Heart rate 2. Lung sounds 3. White blood cell count 4. Level of consciousness

ANS: 3 White blood cell count Rationale: Mitomycin is an antineoplastic medication that can cause bone marrow suppression, which can progress to infection. The priority is to monitor nadirs for neutropenia and thrombocytopenia. Although options 1, 2, and 4 may be a component of the nurse's assessment, assessing the white blood cell count is the priority when administering this medication.

The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? Select all that apply. 1. Increase in lipase level 2. Increase in blood glucose level 3. Increase in serum calcium level 4. Increase in serum potassium level 5. Decrease in low-density lipoprotein levels

ANS: 3, 5 Rationale: Tamoxifen citrate is an antiestrogen and antineoplastic medication. It may increase the calcium level and lower the low-density lipoprotein levels. Before the initiation of therapy, the complete blood count (CBC), platelet count, and serum calcium levels should be determined. These blood levels should continue to be monitored periodically during therapy. The nurse should monitor for signs of hypercalcemia while the client is taking this medication. These signs include increased urine volume, excessive thirst, nausea, vomiting, constipation, decreased muscle tone, and deep bone or flank pain. Options 1, 2, and 4 are not associated with this medication.

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.

ANS: 3, 5, 6 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.

A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. What is the most appropriate nursing response? 1. "Your friends are correct." 2. "You will not lose your hair." 3. "Hair loss may occur, but it will grow back just as it is now." 4. "Hair loss may occur, and it will grow back, but it may have a different color or texture."

ANS: 4 "Hair loss may occur, and it will grow back, but it may have a different color or texture." Rationale: Alopecia (hair loss) can occur after the administration of many antineoplastic medications. Alopecia is reversible, but the new hair growth may have a different color and texture. Therefore, options 1, 2, and 3 are incorrect.

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."

ANS: 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.

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

ANS: 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 who is receiving asparaginase. The nurse should monitor the client for improvement of which condition? 1. Lung cancer 2. Breast cancer 3. Metastatic prostate cancer 4. Acute lymphocytic leukemia

ANS: 4 Acute lymphocytic leukemia Rationale: Asparaginase is indicated for the treatment of acute lymphocytic leukemia. Lung cancer, breast cancer, and metastatic prostate cancer are treated with other antineoplastic agents.

The nurse is reviewing the record of a client who arrives at the health care clinic. The nurse notes that the client is taking letrozole. The nurse should suspect that the client has which disorder? 1. Hypothyroidism 2. Diabetes mellitus 3. Chronic kidney disease 4. Advanced breast cancer

ANS: 4 Advanced breast cancer Rationale: Letrozole is used in the palliative treatment for advanced breast cancer in the postmenopausal woman with disease progression after treatment with antiestrogen therapy. The conditions in options 1, 2, and 3 are not treated with this medication.

The nurse is caring for a client receiving combination chemotherapy. Which nursing intervention is the most appropriate? 1. Give 2 agents from the same medication class. 2. Give 2 agents with like nadirs at the same time. 3. Test the client's knowledge about each agent's nadir. 4. Avoid giving agents with the same nadirs and toxicities at the same time.

ANS: 4 Avoid giving agents with the same nadirs and toxicities at the same time. Rationale: Each chemotherapeutic agent has a specific nadir. Chemotherapy agents are usually given in combinations (also called regimens or protocols). The goal of administering combination chemotherapy in cycles or specific sequences is to produce additive or synergistic therapeutic effects. Administering several medications with different mechanisms of action and different onsets of nadirs and toxicities enhances tumor cell destruction while minimizing medication resistance and overlapping toxicities.

The health care provider (HCP) writes a prescription for capecitabine for a client who was admitted to the hospital. The nurse should contact the HCP to verify the prescription if which condition is noted in the assessment data? 1. Myalgia 2. Psoriasis 3. Rheumatoid arthritis 4. Chronic kidney disease

ANS: 4 Chronic kidney disease Rationale: Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. A contraindication to the use of this medication is severe renal impairment such as that which occurs in chronic kidney disease. Myalgia, psoriasis, and rheumatoid arthritis are not contraindications to this medication.

Capecitabine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1. Liver function tests 2. Bilirubin level assay 3. Triglyceride level determination 4. Complete blood count (CBC)

ANS: 4 Complete blood count (CBC) Rationale: Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. Bone marrow depression can occur from the use of this medication, and a CBC and blood chemistry studies should be done periodically. Liver function tests, bilirubin level assay, and triglyceride levels are unnecessary.

The nurse is performing an admission assessment of a client with a possible right colon tumor. Which sign or symptom should the nurse anticipate the client may report? 1. Frequent diarrhea 2. Crampy gas pains 3. Flat, ribbon-like stools 4. Dull abdominal pain exacerbated by walking

ANS: 4 Dull abdominal pain exacerbated by walking Rationale: Characteristic symptoms of right colon tumors include vague, dull, abdominal pain exacerbated by walking and dark red- or mahogany-colored blood mixed in the stool. The symptoms described in the other options are associated with left colon tumors.

The nurse is monitoring a client with leukemia who is receiving doxorubicin by intravenous infusion. The nurse should monitor for which finding that would indicate doxorubicin toxicity? 1. Elevaged creatinine 2. Red coloration in the urine 3. Elevated blood urea nitrogen (BUN) 4. Electrocardiogram (ECG) changes

ANS: 4 Electrocardiogram (ECG) changes

A client with leukemia is receiving busulfan and allopurinol. The nurse should tell the client that the purpose of the allopurinol is to prevent which symptom? 1. Nausea 2. Alopecia 3. Vomiting 4. Hyperuricemia

ANS: 4 Hyperuricemia Rationale: Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increase as a result of the massive cell destruction that occurs because of the chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy. Allopurinol is not used to prevent alopecia, nausea, or vomiting.

The nurse tells a client with leukemia who is receiving chemotherapy that allopurinol has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent which problem? 1. Nausea 2. Diarrhea 3. Muscle spasms 4. Hyperuricemia

ANS: 4 Hyperuricemia Rationale: Chemotherapy destroys cells, leading to the release of uric acid into the bloodstream. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute kidney injury. Allopurinol, an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil therapy to prevent stomatitis. Allopurinol is not used to treat nausea, diarrhea, or muscle spasms.

The nurse is monitoring a client with chronic lymphocytic leukemia (CLL). Which sign should the nurse specifically monitor for and report to the health care provider? 1. Anemia 2. Bleeding 3. Pancytopenia 4. Lymphadenopathy

ANS: 4 Lymphadenopathy Rationale: CLL causes a slow increase in immature B cells. These cells infiltrate the bone marrow, lymph nodes, spleen, and liver. CLL eventually causes bone marrow failure; therefore, the client will have enlarged and swollen lymph nodes. Options 1 and 2 are clinical manifestations of acute leukemias. Option 3 is a clinical manifestation of hairy cell leukemia.

The nurse is providing care to a client who has undergone modified right mastectomy for the treatment of breast cancer. Which activity should the nurse incorporate into the plan of care? 1. Keep suction drains fully inflated to provide adequate suction. 2. Perform venipunctures and blood pressures on the operative side only. 3. Inform the client that drains will be removed on the second postoperative day. 4. Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow.

ANS: 4 Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow. Rationale: The client should have the head of the bed elevated at least 30 degrees with the affected arm elevated on a pillow. Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. Gentle suction must be maintained on the drain bulb to prevent fluid accumulation at the operative site. With short hospital stays, drainage tubes are usually removed about 1 to 3 weeks after hospital discharge when the client returns for an office visit. All staff must avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood.

The nurse is collecting subjective and objective data from a client and notes that the client is taking capecitabine. The nurse determines that this medication has been prescribed to treat which condition? 1. Hypothyroidism 2. Kidney dysfunction 3. Cushing's syndrome 4. Metastatic breast cancer

ANS: 4 Metastatic breast cancer Rationale: Capecitabine is an antimetabolite used to treat metastatic breast cancer that is resistant to other therapy. It also is used to treat colon cancer. It is not used to treat hypothyroidism, kidney dysfunction, or Cushing's syndrome.

The client has undergone mastectomy. The nurse determines that the client is making the best adjustment to the loss of the breast if which behavior is observed? 1. Refusing to look at the wound 2. Reading the postoperative care booklet 3. Asking for pain medication when needed 4. Participating in the care of the surgical drain

ANS: 4 Participating in the care of the surgical drain Rationale: The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that are in place for a short time after discharge. Refusing to look at the wound indicates no adaptation to the loss. Reading the postoperative care booklet is useful but is not the best of the options presented here. Asking for pain medication is an action-oriented option, but it does not relate to acceptance of the loss of the breast.

The nurse is reviewing the medical record for a client who has been diagnosed with Hodgkin's disease. The nurse should check which diagnostic test noted in the client's record to determine the stage of the disease? 1. Blood studies 2. Bone marrow examination 3. Excisional lymph node biopsy 4. Positron emission topography (PET)

ANS: 4 Positron emission topography (PET) Rationale: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue. It is characterized by painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Diagnostic testing for this disorder includes blood studies, excisional lymph node biopsy, bone marrow examination, and radiographic studies. These tests are used for evaluation purpose but are not definitive. PET scan with or without computed tomography is used to diagnose and determine the stage of the disease.

A client with small cell lung cancer is being treated with etoposide. The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension

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

A client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Peripheral neuropathy

ANS: 4 Rationale: An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all antineoplastic medications. Chest pain is unrelated to this medication.

A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function studies

ANS: 4 Rationale: Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

A client with non-Hodgkin's lymphoma is receiving daunorubicin. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? 1. Fever 2. Sores in the mouth and throat 3. Complaints of nausea and vomiting 4. Crackles on auscultation of the lungs

ANS: 4 Rationale: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure (lung crackles) is an adverse effect of daunorubicin. Bone marrow depression is also an adverse effect. Fever is a frequent side effect and sores in the mouth and throat can occur occasionally. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Options 1, 2, and 3 are not adverse effects.

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

ANS: 4 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.

The nurse is participating in a health screening clinic and is preparing teaching materials about colorectal cancer. Which risk factor for colorectal cancer should the nurse include? 1. High-fiber, low-fat diet 2. Age older than 30 years 3. Distant relative with colorectal cancer 4. Personal history of ulcerative colitis or gastrointestinal polyps

ANS: 4 Rationale: Common risk factors for colorectal cancer include age older than 40 years; first-degree relative with colorectal cancer; high-fat, low-fiber diet; and history of bowel problems, such as ulcerative colitis or familial polyposis.

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

ANS: 4 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 nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency? 1. Headache 2. Dysphagia 3. Constipation 4. Electrocardiographic changes

ANS: 4 Rationale: Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.

Megestrol acetate, an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the health care provider if which diagnosis is documented in the client's history? 1. Gout 2. Asthma 3. Myocardial infarction 4. Venous thromboembolism

ANS: 4 Rationale: Megestrol acetate suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of venous thromboembolism. Options 1, 2, and 3 are not contraindications for this medication.

A client has been hospitalized for removal of a cervical radiation implant used to treat cancer. The implant is removed, and the nurse provides home care instructions to the client. Which statement made by the client indicates a need for further instruction? 1. "Cream may be used to relieve dryness or itching." 2. "Some vaginal bleeding is expected for 1 to 3 months." 3. "Sexual intercourse may be resumed after 7 to 10 days." 4. "Foul-smelling vaginal discharge is a sign of an infection."

ANS: 4 Rationale: Some foul-smelling vaginal discharge is expected and is not a sign of an infection in this client. As well, this type of discharge will occur for some time after removal of a cervical radiation implant. All other options are accurate discharge instructions.

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."

ANS: 4 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 home care nurse visits a client who has just returned home from the hospital after a mastectomy with a suction drain in place. Which observed client behavior requires a need for further teaching? 1. Empties the drain to prevent infection 2. Elevates the arm when lying and sitting 3. Applies lotion to the area after the incision heals 4. Performs full range-of-motion exercises to the upper arm.

ANS: 4 Rationale: The client should be instructed to limit upper arm range-of-motion exercises to the level of the shoulder only. Once the suction drain has been removed, the client can begin full range-of-motion exercises to the upper arm as prescribed. The client should elevate the arm while sitting down or lying, and the client will be able to apply lotion to the incision once it has healed. The drain is emptied as needed.

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.

ANS: 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 receiving chemotherapy is experiencing mucositis. The nurse should advise the client to use which item as the best substance to rinse the mouth? 1. Alcohol-based mouthwash 2. Hydrogen peroxide mixture 3. Lemon-flavored mouthwash 4. Weak salt and bicarbonate mouth rinse

ANS: 4 Weak salt and bicarbonate mouth rinse Rationale: An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of the presence of severe plaque, it should be a weak solution, because hydrogen peroxide dries the mucous membranes.

The nurse caring for a client receiving vincristine is monitoring the client for toxicity. The nurse interprets that the client is experiencing a toxic effect of this medication on the basis of which assessment finding? 1. Nausea and vomiting 2. Decreased platelet count 3. Decreased white blood cell count 4. Weakness and sensory loss in the legs

ANS: 4 Weakness and sensory loss in the legs Rationale: Peripheral neuropathy is the major dose-limiting toxicity associated with vincristine. Nearly all clients exhibit signs and symptoms of sensory or motor nerve injury such as decreased reflexes, weakness, paresthesia, and sensory loss. Nausea and vomiting are rare with the use of this medication. In contrast with most anticancer medications, vincristine causes little toxicity to bone marrow.

A 67-year-old man is receiving outpatient radiation treatments for carcinoma of the oropharynx and has developed dysphagia. The nurse develops a teaching plan regarding dysphagia and includes which interventions in the plan? Select all that apply. 1. Teach the man to speak slowly. 2. Teach the man to enunciate clearly. 3. Encourage the man to drink only thin liquids. 4. Teach the man to examine his oral mucosa daily. 5. Encourage the man to use artificial saliva to manage dryness.

ANS: 4, 5 Rationale: Epithelial cells of the head and neck are destroyed by radiation. Examining the oral mucosa is a preventive intervention so that changes in the mucosa will be noted immediately. Inflammation and ulceration also occur because of rapid cell destruction, thereby impairing normal saliva excretion and distribution. Artificial saliva aids in preventing further damage by lubricating the affected area. The client with dysphagia has difficulty swallowing, not difficulty speaking; therefore, teaching him to speak slowly and enunciate clearly will provide no health benefit for his impairment in swallowing. A client with difficulty swallowing should avoid drinking thin liquids because of the increased risk of aspiration owing to epiglottis dysfunction related to radiation therapy.