NCLEX PrepU - Oncology

A nurse is assessing a female who is receiving her second administration of chemotherapy for breast cancer. When obtaining this client's health history, what is the most important information the nurse should obtain?

"Have you had nausea or vomiting?" Chemotherapy agents typically cause nausea and vomiting when not controlled by antiemetic drugs. Antineoplastic drugs attack rapidly growing normal cells, such as in the gastrointestinal tract. These drugs also stimulate the vomiting center in the brain. Hair loss, loss of energy, and sleep are important aspects of the health history, but not as critical as the potential for dehydration and electrolyte imbalance caused by nausea and vomiting.

Which of the following statements indicates that the client needs further teaching about taking medication to control cancer pain?

"I should skip doses periodically so I don't get hooked on my drugs." The client should not skip his dosages of pain medication to prevent addiction. Clients with cancer pain do not become psychologically dependent on the medication and should not fear becoming addicted. The nurse should allow the client and family members to verbalize their concerns about drug addiction.

A 76-year-old client tells the nurse that she has lived long and does not need mammograms. Which is the nurse's best response?

"The incidence of breast cancer increases with age." Explanation: Advancing age in postmenopausal women has been identified as a risk factor for breast cancer. A 76-year-old client needs monthly breast self-examination and a yearly clinical breast examination and mammogram to comply with the screening schedule. While mammograms are less painful as breast tissue becomes softer, the nurse should advise the woman to have the mammogram. Family history is important, but only about 5% of breast cancers are genetic.

During a breast examination, which finding most strongly suggests that a client has breast cancer?

A fixed nodular mass with dimpling of the overlying skin A fixed nodular mass with dimpling of the overlying skin is common during late stages of breast cancer. Many women have slightly asymmetrical breasts. Bloody nipple discharge is a sign of intraductal papilloma, a benign condition. Multiple firm, round, freely movable masses that change with the menstrual cycle indicate fibrocystic breasts, a benign condition. (less)

A client receiving 5-fluorouracil is experiencing nausea and vomiting. Which is the nurse's best course of action?

Administer odansetron prior to administering the 5-fluorouracil Explanation: Fluorouracil, an antimetabolite antineoplastic medication, may cause nausea, vomiting, diarrhea, bone marrow suppression, and stomatitis. Premedication with an antiemetic medication such as odansetron will prevent nausea and vomiting during treatment.

A nurse is checking the laboratory results of an adult client with colon cancer admitted for further chemotherapy. The client has lost 30 lb (13.6 kg) since initiation of the treatment. Which laboratory result should be reported to the health care provider?

Albumin level of 2.8 g/dl (28 g/L). The nurse must recognize that an albumin level of 2.8 g/dl (28 g/L) indicates catabolism and potential for malnutrition. Normal albumin is 3.5 to 5.0 g/dl (30 to 50 g/L); less than 3.5 g/dl (35 g/L) indicates malnutrition. The other laboratory results are normal.

A client with cancer is receiving chemotherapy. The nurse should assess which of the following diagnostic values while the client is receiving chemotherapy?

Bone Marrow cells The fast-growing, normal cells most likely to be affected by certain cancer treatments are blood-forming cells in the bone marrow, as well as cells in the digestive tract, reproductive system, and hair follicles. Fortunately, most normal cells recover quickly when treatment is over. Bone marrow suppression (decreased ability of the bone marrow to manufacture blood cells) is a common side effect of chemotherapy. A low white blood cell count (neutropenia) increases the risk for infection during chemotherapy, but other blood cells made in the bone marrow can be affected as well. Most cancer agents do not affect tissues and organs, such as the heart, liver, and pancreas.

The nurse is preparing an educational program on breast cancer for women at a Black community center. What information is important for the nurse to consider for the discussion?

Breast cancer concerns vary between socioeconomic levels of Black women. The nurse needs to consider the beliefs and concerns for all socioeconomic levels of Black women when providing education on breast cancer. Access to screening and care may differ. Black women are more likely to develop breast cancer and be diagnosed later in the disease process than Caucasian women. Not all Black women believe that breast cancer is inevitable.

The client who is receiving chemotherapy is not eating well but otherwise feels healthy. Which meal suggestion would be best for this client?

Broiled chicken, green beans, and cottage cheese Carbohydrates are the first substance used by the body for energy. Proteins are needed to maintain muscle mass, repair tissue, and maintain osmotic pressure in the vascular system. Fats, in a small amount, are needed for energy production. Chicken, green beans, and cottage cheese are the best selection to provide a nutritionally well-balanced diet of carbohydrate, protein, and a small amount of fat. Cereal with milk and strawberries as well as toast, gelatin dessert, and cookies have a large amount of carbohydrates and not enough protein. Steak and french fries provide some carbohydrates and a good deal of protein; however, they also provide a large amount of fat.

A nurse is caring for a client with a long-term central venous catheter. Which steps should the nurse include in teaching how to care for his catheter at home?

Clean the port with an alcohol pad before administering I.V. fluid through the catheter. Clients should be instructed to clean the port with an alcohol pad before administering I.V. fluid through the catheter to prevent microorganisms from entering the bloodstream. Using clean technique when accessing the port with a needle, cleaning the needle with a povidone-iodine solution, or flushing each port using the same syringe would break sterile technique.

The nurse is conducting an initial nursing history of a client who is experiencing pain related to bone cancer. The most important information to gather in this initial assessment is the:

Client's self-reporting of the pain experience. The most important component of pain assessment is the client's self-report of the pain. The nurse should have the client describe the quality, location, and intensity of the pain; the client's response to the pain; and any alleviating or aggravating factors affecting the pain. The physical assessment should follow the pain assessment and should be delayed if the client is uncomfortable. The family's response to the client's illness casts light on the amount of support the client has and alerts the nurse to potential problems. With care, however, these concerns are secondary to the issue of pain control.

The nurse is working at the local family planning clinic doing family education. When devising a teaching plan, in which client group would the nurse stress the importance of an annual Papanicolaou test?

Clients infected with the human papillomavirus (HPV). Annual Papanicolaou testing is a screening to detect potential precancerous and cancerous cells in the endocervical canal of the female reproductive system. HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of oral contraceptives do not increase the risk of cervical cancer.

After a lobectomy for lung cancer, the nurse instructs the client to perform deep-breathing exercises to:

Expand the alveoli and increase lung surface available for ventilation. Deep breathing helps prevent microatelectasis and pneumonitis and also helps force air and fluid out of the pleural space into the chest tubes. It does not decrease blood flow to the lungs or control the rate of air flow. The diaphragm is the major muscle of respiration; deep breathing causes it to descend, thereby increasing the ventilating surface.

What should a male client older than age 50 do to help ensure early identification of prostate cancer?

Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. Correct Explanation: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastasis.

The nurse is speaking to a group of women about early detection of breast cancer. Which screening does the nurse recommend to women age 50 and older?

Have a mammogram annually The Canadian Cancer Society states at 50 years that women should have a mammogram annually and a clinical examination at least annually (not every 2 years). The American Cancer Society recommends mammography yearly beginning at age 40. All women should perform breast self-examination monthly (not annually). The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen or progesterone dependent. An annual breast exam by a healthcare provider should be performed.

A client with suspected cervical cancer is undergoing a colposcopy with conization. The nurse gives instructions to the client about her menstrual periods, emphasizing that:

Her next two or three periods may be heavier and more prolonged than usual. The client should be informed that her next two or three periods could be heavy and prolonged. The client is instructed to report any excessive bleeding. The nurse should reinforce the necessity for the follow-up check and the review of the biopsy results with the client. The client's periods will not be normal for 2 to 3 months.

A nurse is assessing a client with metastatic lung cancer. The nurse should assess the client specifically for:

Hoarseness - may indicate metastatic disease to the recurrent laryngeal nerve and is commonly noted with left upper lobe lung tumors. Diarrhea and constipation are not associated with lung cancer. Weight loss, not weight gain, can be a symptom of extensive disease.

The nurse should consider which of the following principles when developing a plan of care to manage a client's pain from cancer?

Individualize the pain medication regimen for the client. The nurse should work with the client to individualize the plan of care for managing pain. Cancer pain is best managed with a combination of medications, and each client needs to be worked with individually to find the treatment regimen that works best. Cancer pain is commonly undertreated because of fear of addiction. The client who is in pain needs the appropriate level of analgesic and needs to be reassured that he will not become addicted. Cancer pain is best treated with regularly scheduled doses of medication. Administering the medication only when the client asks for it will not lead to adequate pain control. As drug tolerance develops, the dosage of the medication can be increased.

A medication nurse is preparing to administer 9 a.m. medications to a client with liver cancer. Which consideration is the nurse's highest priority?

Metabolism of the medication. The rate and ability of the liver to metabolize medications will be altered in a client with liver cancer. Therefore, it is essential to understand how each medication is metabolized. The other considerations are important but not as vital.

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?

Nonmobile mass with irregular edges Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction — not eversion — may be a sign of cancer.

After surgery for gastric cancer, a client is scheduled to undergo radiation therapy. It will be most important for the nurse to include information about which of the following in the client's teaching plan?

Nutritional intake. Correct Explanation: Clients who have had gastric surgery are prone to postoperative complications, such as dumping syndrome and postprandial hypoglycemia, that can affect nutritional intake. Vitamin absorption can also be an issue, depending on the extent of the gastric surgery. Radiation therapy to the upper gastrointestinal area also can affect nutritional intake by causing anorexia, nausea, and esophagitis. The client would not be expected to develop alopecia. Exercise and activity levels as well as access to community resources are important teaching areas, but nutritional intake is a priority need.

After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer?

Pituitary carcinoma Pituitary carcinoma most commonly arises in the anterior pituitary (adenohypophysis) and must be removed by way of a transsphenoidal approach, using a bivalve speculum and rongeur. Surgery to treat esophageal carcinoma usually is palliative and involves esophagogastrectomy with jejunostomy. Laryngeal carcinoma may necessitate a laryngectomy. To treat colorectal cancer, the surgeon removes the tumor and any adjacent tissues and lymph nodes that contain cancer cells.

Doxorubicin is prescribed for a female client with breast cancer. The client is distressed about hair loss. The nurse should do which of the following?

Provide resources for a wig selection before hair loss begins. Correct Explanation: Resources should be provided for acquiring a wig since it is easier to match hair style and color before hair loss begins. The client has expressed negative feelings of self image with hair loss. Excessive shampooing and manipulation of hair will increase hair loss. Hair usually grows back in 3 to 4 weeks after the chemotherapy is finished, however new hair may have a new color or texture. A wig, hairpiece, hat, scarf, or turban can be used to conceal hair loss. Social isolation should be avoided and the client should be encouraged to socialize with others.

Which of the following observations should the nurse make first when the client who has had a modified radical mastectomy returns from the operating room to the recovery room?

Provide resources for a wig selection before hair loss begins. Correct Explanation: Resources should be provided for acquiring a wig since it is easier to match hair style and color before hair loss begins. The client has expressed negative feelings of self image with hair loss. Excessive shampooing and manipulation of hair will increase hair loss. Hair usually grows back in 3 to 4 weeks after the chemotherapy is finished, however new hair may have a new color or texture. A wig, hairpiece, hat, scarf, or turban can be used to conceal hair loss. Social isolation should be avoided and the client should be encouraged to socialize with others.

Which of the following measures is most important for pain management for a client after a lobectomy for lung cancer?

Reassess the client after administering pain medication. Correct Explanation: It is essential for the nurse to evaluate the effects of pain medication after it has had time to act. Although other interventions may be appropriate, continual reassessment is most important to determine the effectiveness and need for additional intervention, if any. Repositioning could provide some comfort, but assessment of the client's pain level is essential. Reassuring the client is important, but it will be of no value unless the nurse evaluates the client's pain level. To readjust the pain dosage is appropriate only if titration is prescribed by the physician.

A client with stage II ovarian cancer undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. During the second postoperative day, which assessment finding requires immediate intervention?

Shallow breathing and lethargy - Shallow breathing and a change in the level of consciousness, such as increasing lethargy requires immediate intervention because they may indicate a respiratory complication — for example, atelectasis or carbon dioxide retention. To avoid respiratory complications, the nurse should encourage turning, coughing, deep breathing, and ambulation during the early postoperative period. Abdominal pain, hypoactive bowel sounds, and serous drainage from the incision are expected findings during the first few days after this type of surgery.

A client had a total abdominal hysterectomy and bilateral oophorectomy for ovarian carcinoma yesterday. She received 2 mg of morphine sulfate I.V. by patient-controlled analgesia (PCA) 10 minutes ago. The nurse was assisting her from the bed to a chair when the client felt dizzy and fell into the chair. The nurse should:

Take the client's blood pressure. The nurse should take the client's blood pressure. She is likely experiencing orthostatic hypotension. The PCA pump does not need to be discontinued because, as soon as the blood pressure stabilizes, the pain medication can be resumed. Administering oxygen is not necessary unless the oxygen saturation also drops. The client should sit in the chair until the blood pressure stabilizes

A 56-year-old woman is admitted for a modified radical mastectomy. The client appears anxious and asks many questions. The nurse's best course of action is to:

Tell the client as much as she wants to know and is able to understand. An important nursing responsibility is preoperative teaching. The recommended guide for teaching is to tell the client as much as she wants to know and is able to understand. Delaying discussion of issues or concerns will most likely increase the client's anxiety. Telling the client to discuss questions with the physician avoids acknowledging the client's concerns.

Which of the following statements is most accurate regarding the long-term toxic effects of cancer treatments on the immune system?

The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. Studies of long-term immunologic effects in clients treated for leukemia, Hodgkin's disease, and breast cancer reveal that combination treatments of chemotherapy and radiation can cause overall bone marrow suppression, decreased leukocyte counts, and profound immunosuppression. Persistent and severe immunologic impairment may follow radiation and chemotherapy (especially multiagent therapy). There is no evidence of greater risk of infection in clients with persistent immunologic abnormalities. Suppressor T cells recover more rapidly than the helper T cells.

A client receiving radiation therapy for thyroid cancer reports mouth and throat pain. While inspecting the mouth and throat, the nurse notices white patches and ulcerations in the oral mucosa. The nurse notifies the radiation oncologist, and expects which intervention for this client?

To administer an antifungal agent Correct Explanation: White patches and ulcers in the mouth and throat suggest Candidiasis, which is common in immunocompromised clients and in those receiving radiation therapy. It is treated with antifungal agents, as well as by offering yogurt and frequent medicated mouthwash rinses. Oral intake should be encouraged to maintain hydration. Weight loss may occur if left untreated, there is no indication that a daily weight is required at this time. Referring the client to a dentist may be necessary if the ulcers are due to something other than Candidiasis

The development of laryngeal cancer is most clearly linked to which of the following factors?

alcohol and tobacco use Predisposing factors for laryngeal cancer include chronic irritants such as alcohol, tobacco, and exposure to noxious fumes. About 75% of people who develop laryngeal cancer are smokers. The combination of smoking and heavy alcohol intake is even more strongly implicated as a causative agent in laryngeal cancer. Epidemiologic studies indicate that a high-fat diet may be a major factor in the development of cancer of the breast, prostate, and colon, but not laryngeal cancer. Low socioeconomic status is a predisposing factor in cervical cancer but not laryngeal cancer. Artificial sweeteners have been related to the incidence of bladder cancer, but not laryngeal cancer.

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include:

chemotherapy exposure and risk factors. The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.

A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would be most therapeutic for the client?

encouraging him to express his feelings nonverbally and in writing The client has undergone body changes and permanent loss of verbal communication. He may feel isolated and insecure. The nurse can encourage him to express his feelings and use this information to develop an appropriate plan of care. Discussing the client's behavior with his wife may not reveal his feelings. Exploring future plans is not appropriate at this time because more information about the client's behavior is needed before proceeding to this level. The nurse can respect the client's need for privacy while also encouraging him to express his feelings

A 3-year-old child receiving chemotherapy after surgery for a Wilms' tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would not be appropriate for this child?

fresh strawberries When a client receiving chemotherapy develops neutropenia, eating uncooked fruits and vegetables may pose a health risk due to possible bacterial contamination. All other foods are either cooked or pasteurized and would not produce a health risk.

A client with metastatic brain cancer is admitted to the oncology floor. According to the Self-Determination Act of 1991 concerning the execution of an advance directive, the hospital is required to:

inform the client or legal guardian of their rights to execute an advance directive. The client Self-Determination Act of 1991 requires all health care facilities to notify clients upon admission of their right to execute an advance directive. The facility's ethics committee can decide on a treatment plan if the client is unable and a health care power of attorney hasn't been appointed. Hospital employees aren't required by law to respect an individual's moral rights; however, the health care professional should respect the client's individual rights as part of his professional responsibility. Health care professionals are sometimes concerned that advance directives prevent treatment that might help the client. However, the hospital isn't required to advise clients not to execute their advance directive.

The client asks the nurse to explain what it means that his Hodgkin's disease is diagnosed at stage 1A. What describes the involvement of the disease?

involvement of a single lymph node In the staging process, the designations A and B signify that symptoms were or were not present when Hodgkin's disease was found, respectively. The Roman numerals I through IV indicate the extent and location of involvement of the disease. Stage I indicates involvement of a single lymph node; stage II, two or more lymph nodes on the same side of the diaphragm; stage III, lymph node regions on both sides of the diaphragm; and stage IV, diffuse disease of one or more extralymphatic organs.

A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults?

papillary carcinoma Papillary carcinoma accounts for about 70% of thyroid cancer cases in adults. Follicular carcinoma accounts for roughly 15%; anaplastic carcinoma, about 5%; and medullary carcinoma, about 5%.

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for:

pathologic bone fractures Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

A nurse preparing to discharge a client to his home determines that he will need IV antibiotics for 3 weeks. To prevent a delay in service, the nurse needs to carry out which of the following items? Select all that apply.

• Contact the home care agency and provide a detailed report on the client. • Fax the physician's orders and referral documents to the home care agency. • Obtain an order for insertion of a PICC (peripherally inserted central catheter). Explanation: In order to facilitate a timely discharge, the nurse will need to contact the home care agency and provide a detailed report on the client, fax the physician's orders and referral documents to the home care agency, and obtain an order for insertion of a PICC. It is the responsibility of the case manager to determine whether the client's insurance carrier will cover the item. The physician's orders for the antibiotics are sent to the home care agency, not to the hospital pharmacy. (less)

A nurse is planning an education program on breast cancer for a community group of women who are of child-bearing age. The nurse plans to base the discussion on the American Cancer Association and Canadian Cancer Association guidelines. Which of the following should the nurse plan to include in the discussion? Select all that apply.

• Women who have a family history of breast cancer should obtain their first mammogram at the age of 35. • Women should begin getting annual mammograms beginning at 40 years of age. Explanation: The American Cancer Association and Canadian Cancer Association recommend that women should obtain a yearly mammogram at the age of 40 and those who have a family history of breast cancer in first degree relatives should obtain a baseline mammogram at the age of 35. Women between the ages of 22 and 30 should perform breast self-examinations and have a clinical breast exam every 3 years.