PrepU: Cancer/end of life

A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client?

fear -Fear of the unknown is probably the major concern for this client. Fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Ineffective Coping can be illustrated by the client's refusal to talk about the problem, but no excess or abnormal behavior has been identified at this time.

A nurse is caring for a client with prostate cancer and assesses bleeding gums and hematuria. What serum indicator should the nurse relate the bleeding?

platelet count of 60,000/mm3 -Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer and is usually defined as a count less than 100,000/mm3. The risk of bleeding increases as the count drops lower. The risk of spontaneous bleeding occurs with a count of less than 20,000/mm3.

Evidence-based medical and nursing research (2009) has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following?

Write a prescription for a serum cholesterol level. -Hypercholesterolemia is the most prevalent chronic disease in the United States, with 37.5% of all adults affected. Refer to Table 3-1 in the text.

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?

autologous -Autologous vaccines are made from the client's own cancer cells, which are obtained during diagnostic biopsy or surgery. Prophylactic vaccines, such as the polio vaccine, are given to prevent people from developing a disease. Therapeutic vaccines are given to kill existing cancer cells and to provide long-lasting immunity against further cancer development. Allogeneic vaccines are made from cancer cells that are obtained from other people who have a specific type of cancer.

While doing a health history, a client tells the nurse that her mother, grandmother, and sister died of cancer. The client wants to know what she can do to keep from getting cancer. What would be the nurse's best response?

"You can't prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is." -Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. Telling the client to make lifestyle changes and that there is nothing the client can do with their family history would be giving inaccurate information. Telling the client that cancer often skips a generation and not to worry is incorrect because it minimizes and negates the clients concern.

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client?

Monitor the client to prevent sepsis. -Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.

The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as

brachytherapy -Brachytherapy is the only term used to denote the use of internal radiation implants.

The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is:

cell-cycle nonspecific. -Antitumor antibiotics are cell-cycle nonspecific; they interfere with deoxyribonucleic acid (DNA) synthesis by binding with the DNA. They also prevent ribonucleic acid synthesis. Other cell-cycle nonspecific drugs include nitrosoureas and hormonal agents. Drugs that are cell-cycle specific in the S phase include topoisomerase I inhibitors and antimetabolites. Miotic spindle poisons are cell-cycle specific in the M phase. There isn't a drug class that's specific to the P phase.

A decrease in circulating white blood cells (WBCs) is referred to as

leukopenia -A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low absolute neutrophil count.

A family of a dying client reports that their loved one is experiencing more shortness of breath. Which nursing intervention is most appropriate at this time?

Call the health care provider to obtain an oxygen order -Obtaining an oxygen order can reduce the client's shortness of breath and help the family feel more comfortable. It is difficult for families to see the client with shortness of breath. The dying client and family need support, and the bedpan, sitting in a chair, or offering sips to drink do not address the feelings of shortness of breath.

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?

Durable power of attorney for health care -A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.

The nurse at the clinic explains to the patient that the surgeon will be removing a mole on the patient's back that has the potential to develop into cancer. The nurse informs the patient that this is what type of procedure?

prophylactic -Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk of developing cancer. When surgical cure is not possible, the goals of surgical interventions are to relieve symptoms, make the patient as comfortable as possible, and promote quality of life as defined by the patient and family. Palliative surgery and other interventions are performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusions (Table 15-6). Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Diagnostic surgery, or biopsy, is performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant.