Saunders Oncology Study Mode “98 Qs”

The nurse is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication that may become a chronic problem related to the surgery?

Arm edema on the operative side Rationale:Clients who undergo mastectomy for breast cancer, especially those with axillary node resection, may develop chronic lymphedema or excessive swelling in the arm and hand. Lymphedema is a complication that may develop immediately after mastectomy, months, or even years after surgery. Slight edema may occur in the immediate postoperative period, but should decrease especially if the client rests with the arm supported on a pillow. Women should avoid injury to the arm on the affected side and not allow venipunctures or blood pressures to be taken in that arm. Pain and numbness near the incision and drainage from the surgical site are expected occurrences after mastectomy and are not indicative of a complication.

The nurse is caring for a client with metastatic lung cancer. The client was medicated 2 hours ago and now reports a new and sudden sharp pain in the back. The nurse appropriately interprets this finding as possible spinal cord compression. Which would the nurse do next?

Ask the client about numbness and tingling in all the extremities. Rationale:Spinal cord compression should be suspected in a client with metastatic disease, particularly when a new and sudden onset of back pain occurs. Spinal cord compression causes back pain before neurological changes occur. The nurse should gather more data and determine if the client has numbness or tingling and mobility changes in the extremities. Then the PHCP is notified. Spinal cord compression is an oncological emergency and needs to be reported. Additional pain medication and listening to breath sounds may be done, but these are not priority interventions.

A client receiving chemotherapy asks the nurse, "What will I do when my hair starts to fall out?" Which action by the nurse is therapeutic?

Assist her to express feelings. Rationale:The nurse should encourage the client to express her feelings initially. Selecting a wig before the hair falls out will enable the client to better match hair color and texture of the wig with her natural hair. A new hairstyle will not be beneficial to the client because the hair will have fallen out. Option 3 is nontherapeutic, and option 4 can be considered false reassurance.

The nurse is assisting in preparing a teaching plan of care for a client being discharged from the hospital following surgery for testicular cancer. Which instruction would the nurse suggest to include in the plan?

"An elevation in temperature should be reported to the primary health care provider." Rationale:For the client who has had testicular surgery, the nurse should emphasize the importance of notifying the primary health care provider if chills, fever, drainage, redness, or discharge occurs. These symptoms may indicate the presence of an infection. Often a prosthesis is inserted during surgery, so the client does not have to wait 6 months. The nurse instructs the client that he will be able to resume most of his usual activities within 1 week after discharge, except for lifting heavy objects (those weighing 20 pounds or more) and stair-climbing.

The nurse is preparing a client for an intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. The nurse provides instructions to the client regarding the procedure. Which client statement indicates an understanding of this procedure?

"After the instillation is done, I will need to change position every 15 minutes from side to side." Rationale: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 is to change position every 15 to 30 minutes from side to side, and from supine to prone, or to resume all activity immediately during this time period. This allows the chemotherapeutic agent to be in contact with all areas inside the bladder. The client then voids and is instructed to drink water to flush the bladder.

The nurse is reinforcing instructions to a group of high school males in a health class about how to perform a testicular self-examination (TSE). The nurse would make which statement?

"Do the examination after a warm bath or shower." Rationale:Testicular cancer is rare but occurs most frequently in males 20 to 35 years of age; therefore, education of high school-aged males is important. TSE is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. It also could be done near the end of the shower. The client should be standing to examine the testicles. The client should use both hands, placing fingers under the scrotum and thumbs on top, and should gently roll the testicles, feeling for any lumps.

The nurse is obtaining data from a client admitted with a diagnosis of bladder cancer. Which question would the nurse ask the client to determine if the client experienced the most common symptom associated with this type of cancer?

"Do you notice any blood in the urine?" Rationale:The most common symptom in clients with cancer of the bladder is hematuria. The client may also experience irritative voiding symptoms such as frequency, urgency, and dysuria, which often are associated with cancer in situ. The nurse's question in option 4 ("Do you experience any pain when you urinate?") will elicit information from the client regarding the most common symptom associated with bladder cancer.

The nurse is collecting data from a client suspected of having OVARIAN cancer. Which question would the nurse ask the client to elicit information specifically related to this disorder?

"Does your abdomen feel as though it is swollen?" Signs/symptoms 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, and constipation. Ascites with dyspnea and ultimately general severe pain will occur as the disease progresses. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.

A client with carcinoma of the breast is admitted to the hospital for treatment with intravenous vincristine. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. After offering an open-ended question in reply, the client expresses how she feels. The nurse then gives the client information. The nurse makes which appropriate response to the client?

"Hair loss may occur, and it will grow back, but it may have a different color or texture." Rationale:Alopecia (hair loss) can occur following the administration of many antineoplastic medications. Alopecia is reversible, but new hair growth may have a different color and texture.

The nurse is collecting data from a client who is admitted to the hospital for diagnostic studies to rule out the presence of Hodgkin's disease. Which question would the nurse ask the client to elicit information specifically related to this disease?

"Have you noticed any swollen lymph nodes?" Rationale:Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extra-lymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not significantly related to the disease.

The nurse is caring for a client who has undergone pelvic exenteration. In addressing psychosocial issues related to the surgery, which statement by the nurse would be therapeutic?

"How do you feel about this surgery?" Rationale:Postoperatively, a woman begins to deal with the trauma of the surgery by expressing grief about her mutilated body. Later she may become depressed or withdrawn or even angry or hostile. The woman needs intense emotional support if she is to adapt to her altered body image and functions. Asking the client how she feels about the surgery is the only option that addresses the client's feelings.

The nurse caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer is reinforcing discharge instructions to the client. Which statement by the client indicates the need for FURTHER teaching regarding care of the stoma?

"I need to use an air conditioner to provide cool air to assist in breathing." Rationale:Air conditioners must be avoided to protect from excessive coldness and dryness in the air. A humidifier in the home should be used if excessive dryness is a problem. Protecting the stoma from water, powders and sprays are correct measures. Preventing the skin around the stomach from cracking is also correct.

The nurse has reinforced discharge instructions regarding home care to a client following a prostatectomy for cancer of the prostate. He is being discharged with an indwelling urinary catheter. Which statement by the client indicates a need for FURTHER teaching?

"I should use the leg bag when I am in bed during the night." Rationale:The post prostatectomy client who is discharged with an indwelling urinary catheter needs to be instructed in maintaining the catheter at home. The nurse reviews the printed instructions with the client and caregiver. They need to understand and know how to empty the catheter and keep it aseptic. The client will attach the leg bag, which can be worn under pants, to drain urine while he is up and about. The drainage bag needs to be kept lower than the bladder to facilitate proper drainage. The urine may have some small blood clots, but there should be no frank bleeding. The catheter will be removed by the urologist during a postoperative office visit by deflating the balloon of the catheter.

A 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 makes which statements? Select all that apply.

"I will increase fluid intake to 2 to 3 L/day." "I will observe my urine carefully for signs of bleeding." Rationale:A toxic effect of cyclophosphamide is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication and observe the urine for bleeding. 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.

The nurse provides skin care instructions to the client who is receiving external radiation therapy. Which statement by the client indicates the need for FURTHER teaching? Select all that apply.

"I will limit sun exposure to 1 hour daily." "I will apply moisturizer with a cotton tipped applicator for itching. " Rationale:The client needs to be instructed to avoid exposure to the sun because of the risk of burns, resulting in altered tissue integrity. No lotions, ointments, or medications should be applied to the skin unless prescribed by the radiologist.

The nurse is reinforcing client education regarding symptoms of testicular cancer. The nurse encourages the client to report which symptoms as being associated with testicular cancer? Select all that apply.

A grainy mass palpated in a testicle An enlargement of one of the testes Rationale:A grainy mass palpated in a testicle and enlargement of the testes are symptoms of testicular cancer and should be reported. Erectile dysfunction can occur from vascular disease as well as diabetes mellitus. Purulent drainage from the penis suggests an infection. Difficulty initiating the urine stream is often experience by men with benign prostatic hypertrophy (BPH).

The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs FURTHER teaching if the client states an intention to take which action? Select all that apply.

Apply pressure on the radiated area to prevent bleeding. Avoid standing within 6 feet of persons under the age of 18 years. Rationale:The client should avoid pressure on the radiated area and wear loose-fitting clothing to prevent a disruption in the skin integrity. A client receiving external radiation is not radioactive and does not need to avoid other persons, including young people. A diet high in protein assists in the healing process. Avoiding sunlight and washing the skin with gentle soap and patting dry will assist with preventing skin disruption.

When reinforcing teaching about signs and symptoms of ovarian cancer with a community group of women, the nurse emphasizes which sign/symptom as being a typical manifestation of the disease recognized by persons diagnosed with the condition?

Abdominal distention or fullness Rationale:Ovarian cancer is the leading cause of death from gynecological cancers and occurs in women older than 50 years. The most common sign and symptom of ovarian cancer is abdominal distention or fullness. Less common are vague symptoms of urinary frequency and urgency and gastrointestinal symptoms such as a change in bowel habits. Pelvic cramping, sharp abdominal pain, or postmenopausal vaginal bleeding are not the most typical signs and symptoms.

The nurse is reinforcing instructions to a group of adults about the seven warning signs of cancer. The nurse determines that a member of the group needs FURTHER teaching if the member states which sign/symptom is a warning sign?

Absence or decreased frequency of menses Rationale:Each of the seven warning signs of cancer begins with a letter from the word CAUTION. The one that is not part of the seven is absence or decreased frequency of menses. This particular item could be indicative of pregnancy or menopause, as well as other pathological problems. Unusual bleeding or discharge, however, is one of the warning signs.

The nurse is orienting a new nurse to the care of a client who has an internal radiation implant. Which statement by the new nurse demonstrates the need for FURTHER teaching?

After visiting hours, the client may be put in a wheel chair and taken out of the room. Rationale:Precautions must be enforced to protect health care workers and visitors when a client has an internal radiation implant. The client must stay in the room and be taken out only for medical reasons approved by the radiologist. If the client sits in a wheelchair the implant may move. Children younger than 16 years of age and pregnant women are not allowed in the client's room. The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the client's room.

The nurse is assisting with conducting a health-promotion program to community members regarding testicular cancer. The nurse determines that FURTHER teaching is needed if a community member states that which is a sign/symptom of testicular cancer? Select all that apply.

Alopecia Elevation in prostate specific antigen (PSA) levels Rationale:Alopecia is not a sign/symptom of testicular cancer. However, it may occur as a result of radiation or chemotherapy. Elevated PSA levels are associated with prostate cancer. Testicular swelling without pain and a feeling of heaviness in the scrotum occur with testicular cancer as a result of the tumor growing. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

The nurse working in an obstetrical-gynecological primary health care provider's office is instructing a small group of premenopausal female clients about breast self-examination (BSE). Which instruction would the nurse reinforce as the first step to begin the BSE?

BSE begins with inspection of the breast standing before a mirror. Rationale:BSE begins with inspection of the breasts while the woman is standing before a mirror. After this is completed the woman then palpates her axilla with her arm only slightly (not fully) raised. The second step of the BSE is vertical pattern palpation of the breasts and the axillary area. The ACS and women's health care experts recommend that the woman lie on her back with a folded towel under the shoulder of the breast to be examined. The arm on the same side is raised above her head.

The nurse is reviewing the health record of a client with laryngeal cancer. The nurse would expect to note which most common risk factor for this type of cancer documented in the record?

Cigarette smoking The most common risk factor associated with laryngeal cancer is cigarette smoking. Alcohol abuse may have a synergistic effect with cigarette smoking. Air pollution is also a contributing cause as are chronic laryngitis and consistent voice strain.

Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse assists in planning care, knowing that which is the primary action of this medication?

Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric (NG) tube. Which action would the nurse take?

Continue to monitor the drainage. Rationale:Following gastrectomy, drainage from the NG tube is normally bloody for 24 hours postoperatively, changing to brown-tinged and then to yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. There is no need to notify the PHCP at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, an NG tube should not be irrigated.

The nurse is assisting in the care of a client diagnosed with multiple myeloma who has been prescribed an intravenous solution of 0.9% normal saline at 125 mL per hour. Which finding would indicate a positive response to this treatment?

Creatinine of 1 mg/dL Rationale:In multiple myeloma, hydration is essential to prevent renal damage from excessive calcium and uric acid in the blood that leads to stone formation. Creatinine is the most accurate measure of renal status, and the level is within the normal range. Weight gain in response to hydration indicates fluid excess, a negative response. The respiratory rate and white blood cell counts are not related to hydration.

The nurse is reviewing the record of a client admitted to the hospital for treatment of bladder cancer. Which risk factor related to this type of cancer would the nurse likely note in the client's record?

Drinks coffee and smokes cigarettes Rationale:The incidence of bladder cancer is greater in men than in women and affects the white population twice as often as African Americans. It most often occurs after the age of 40 years. Environmental health hazards have been attributed as causes. Cigarette smoking and drinking coffee are some factors associated with bladder cancer.

The nurse is collecting data from a client with a history of bladder cancer. Which signs/symptoms would the nurse expect the client to report? Select all that apply.

Dysuria Hematuria Urgency of urination Frequency of urination Rationale:The most common sign of bladder cancer is painless, intermittent hematuria. Other signs and symptoms include bladder irritability; infection with dysuria, frequency, and urgency; and decreased stream of urine. Headache is not associated with bladder cancer, and dull ache in the flank area is associated with renal cancer.

The nurse is assisting in caring for a client with an inoperable lung tumor and helps develop a plan of care by addressing complications related to the disorder. The nurse includes monitoring for the early signs of vena cava syndrome in the plan. Which early sign of this oncological emergency would the nurse include monitoring for in the plan of care?

Edema of the face and eyes 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.

A client with endometrial cancer is receiving doxorubicin, an antineoplastic agent. The nurse would specifically collect data about which criteria? Select all that apply.

Electrocardiogram Hematological laboratory values Rationale:Doxorubicin has adverse/side effects affecting the red and white blood cell counts and platelets. In addition, it is known to be cardiotoxic, causing dysrhythmias and electrocardiogram changes. Because of bone marrow suppression during therapy with antineoplastic agents, hematological laboratory values should be monitored closely. The incorrect options reflect neurological symptoms, which are not the concern with this medication.

The nurse is developing a teaching plan for a client following a radical mastectomy and includes measures that will assist in preventing lymphedema of the affected arm. The nurse would include which interventions when reviewing instructions with the client to prevent this complication? Select all that apply.

Elevate the affected arm on a pillow higher than the heart. Instruct the client to perform simple arm exercises in the affected arm daily. Inspect the arm daily and notify the primary health care provider of redness or swelling. Rationale:The client needs to be aware of the signs of lymphedema and ways to prevent this complication. Following mastectomy, the arm should be elevated above the level of the heart per primary health care provider's prescription. Simple arm exercises should be encouraged. The client should inspect the arm daily and notify the primary health care provider if signs of infection or swelling occur. No blood pressure readings, injections, IV lines, or blood draws should be performed on the affected arm. Cool compresses or ice bags are not a suggested measure for lymphedema prevention. The client should not wear constrictive sleeves, and ace wraps are used as treatment, not prevention.

The nurse is monitoring a client on chemotherapy for signs and symptoms related to tumor lysis syndrome. The nurse understands that which is an early sign of this oncological emergency?

Elevated potassium Rationale:Tumor lysis syndrome is a rapid release of by-products from cell destruction by cancer therapy; the first sign is an elevated potassium level, which may cause renal failure, cardiac dysrhythmias, or asystole.

The nurse is caring for a client after a mastectomy. Which nursing interventions would assist with preventing lymphedema of the affected arm? Select all that apply.

Elevating the affected arm on a pillow above heart level Taking no blood pressure measurements in the affected arm Rationale:Lymphedema is a potential complication of mastectomy, especially if the surgery included axillary node resection. After mastectomy, the primary health care provider's prescriptions regarding positioning are followed. No compression of the arm, as with a blood pressure measurement, should ever be done in the arm. The arm on the surgical side is usually elevated above the level of the heart, and simple arm exercises should be encouraged. No blood pressure readings, injections, IV line insertions, or blood draws should be performed on the affected arm. Cool compresses are not a recommended measure to prevent lymphedema from occurring.

A client with ovarian cancer is scheduled to receive chemotherapy with cisplatin. The nurse assisting in caring for the client reviews the plan of care, expecting to note which interventions? Select all that apply.

Encourage fluids. Monitor serum blood urea nitrogen (BUN) and creatinine levels. Rationale:The client should receive prehydration before and during the infusion of this medication to minimize the risk of renal damage. The BUN and creatinine should be monitored to determine if renal impairment is occurring. Fluids are not restricted. Encouraging adequate dietary intake is appropriate, but a high-protein or low-fat diet is NOT necessary.

The nurse is assisting with developing a plan of care for the client with multiple myeloma. Which nursing intervention would be included to prevent renal failure for this client? Select all that apply.

Encouraging fluids Monitoring serum calcium and uric acid levels Rationale:In order to prevent renal failure in the client with multiple myeloma, the nurse should encourage fluids and monitor serum calcium and uric acid levels. Hypercalcemia secondary to bone destruction is a priority concern in the client with multiple myeloma. The nurse should encourage fluids in adequate amounts to maintain an output of 1.5 L to 2 L a day. Clients require about 3 L of fluid per day. The fluid is needed not only to dilute the calcium and uric acid, but also to prevent protein from precipitating in the renal tubules. Oral care, encouraging coughing and deep breathing, and monitoring the red blood cell count are important for clients with cancer, but these interventions are not specific to prevention of renal failure.

A client is receiving chemotherapy that carries a risk of phototoxicity as an adverse effect. Which finding indicates that the client experienced this side effect?

Erythema Rationale:Typical photosensitivity reactions involve a "sunburn" reaction of the skin. It is characterized by erythema and blister formation. Squinting is a reaction when the eyes are sensitive to light and that term is photophobic. Ecchymoses and petechiae indicate bleeding.

The nurse determines that a client with which history is MOST at risk for endometrial cancer?

Estrogen replacement therapy Rationale:Endometrial cancer is related to the hormone estrogen because estrogen is the primary stimulant of endometrial proliferation. Steroid replacement therapy, occupational exposure to dust, and surgical interventions are not considered to be risk factors for endometrial cancer.

The nurse is reviewing the medical history of a client admitted to the hospital with a diagnosis of colorectal cancer. The nurse understands that which information documented in the medical history are risk factors of this type of cancer? Select all that apply.

Family history of colon cancer A history of inflammatory bowel disease Regular consumption of red or processed meats Regular consumption of a diet high in fats and carbohydrates Rationale:The incidence of colorectal cancer increases with age. Colorectal 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. A diet high in fiber is considered protective again colorectal cancer.

The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which signs and symptoms of the client are associated with Hodgkin's disease? Select all that apply.

Fatigue Weakness Night sweats Enlarged lymph nodes Reminder: what are the side effects of tumor/cancer? Rationale:Hodgkin's disease (lymphoma) is a chronic, progressive neoplastic (he uncontrolled, abnormal growth of cells or tissues in the body, and the abnormal growth itself is called a neoplasm or tumor) disorder of the lymphoid tissue that is characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Other signs and symptoms include fatigue, weakness, weight loss, and night sweats. Weight gain and joint pain are NOT associated with Hodgkin's disease.

The nurse discusses the risk factors associated with gastric cancer as part of a health promotion program. The nurse determines that there is a need for FURTHER teaching if a member attending the program states that which factor is a risk?

High meat and carbohydrate consumption Rationale:Gastric cancer usually begins in the mucosal cells of the stomach. High meat and carbohydrate consumption plays a role in the development of cancer of the pancrease, NOT gastric cancer. Options 1 (History of gastric polyps), 2 (History of pernicious anemia), and 4 (A diet of smoked, highly salted, and spicy food) identify risk factors related to gastric cancer. The risk also is increased for males 50 years of age and older and clients with a history of precancerous lesions or chronic gastritis.

The nurse is reviewing the record of a client with a diagnosis of cervical cancer. Which would the nurse expect to note in the client's record related to a risk factor associated with this type of cancer?

History of human papillomavirus infection Rationale:Risk factors associated with cervical cancer include smoking, intercourse with uncircumcised males, early frequent intercourse with multiple sexual partners, multiparity, chronic cervicitis, and history of genital herpes or human papillomavirus infection. Incidence of cervical cancer is also higher in African Americans.

The nurse is reviewing the laboratory results of a client who has been diagnosed with multiple myeloma. Which finding would the nurse expect to note with this diagnosis?

Increased calcium level Rationale:Findings that are indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia as a result of the release of calcium from the deteriorating bone tissue, and an elevated BUN level. An increased white blood cell count may or may not be present, but this is not specifically related to multiple myeloma.

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 note as a result of the massive cell destruction that occurred from the chemotherapy?

Increased uric acid level Rationale:Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill, releasing uric acid into the blood. Although anemia, decreased platelets, and decreased leukocytes also may be noted, an increased uric acid level is related specifically to cell destruction. Massive cell destruction may result in high levels of potassium, not hypokalemia.

The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding is indicative of the massive cell destruction that occurs with the chemotherapy?

Increased uric acid level Rationale:Hyperuricemia, elevated levels of uric acid, is especially common after treatment for leukemias and lymphomas, because the therapy results in massive cell destruction and the release of uric acid. Anemia (low red blood cell count), low platelet levels, and low white blood cell counts are associated with the bone marrow abnormalities that are a part of the leukemias and lymphoma disease process.

The client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. Besides treatment of the lung cancer, the nurse anticipates that which interventions may be prescribed to treat the SIADH? Select all that apply.

Institute safety measures. Frequently monitor sodium blood levels. Gather data about the neurological status frequently. Administer medication that is antagonistic to antidiuretic hormone (ADH). Rationale:Syndrome of inappropriate ADH (SIADH) is a condition in which 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. SIADH is a potential complication associated with cancer, especially small cell lung cancer. SIADH is managed by treating the condition and its cause. The SIADH induces low sodium blood levels and results in altered neurological states, including confusion and unresponsiveness. Treatment of SIADH includes fluid restriction, increased sodium intake, and a medication with a mechanism of action that is antagonistic to ADH, such as demeclocycline. Sodium blood levels and neurological status are monitored closely and safety interventions must be instituted. The client should not be treated with an increase in fluid intake or a decrease in the sodium intake.

The nurse is teaching a local women's church group about the risks of cervical cancer. The nurse determines that there is a need for FURTHER teaching if a group member states that which is a risk factor?

Intercourse with a circumcised male Rationale:Risk factors associated with cervical cancer include intercourse with uncircumcised males, early frequent intercourse with multiple sexual partners, multiparity, chronic cervicitis, and history of genital herpes or human papillomavirus infection. Cervical cancer is also higher in African Americans.

The nurse is reinforcing instructions to a community group regarding the risks and causes of bladder cancer. The nurse determines that there is a need for FURTHER teaching if a member of the community group makes which statement regarding this type of cancer?

It most often occurs in women. Rationale:The incidence of bladder cancer is greater among men than among women, and it affects the white population twice as often as the black population. Age over 40, environmental exposure to certain chemicals, and cigarettes especially are associated with the incidence of bladder cancer.

The nurse is reinforcing information regarding chemotherapy with a client who has been diagnosed with cancer. The nurse tells the client that which is an advantage of continuous intravenous (IV) chemotherapy?

It uses smaller doses to kill cancer cells, so it is less toxic to normal tissues. Rationale:Continuous IV chemotherapy may be done over a period of hours, days, or weeks. A distinct advantage is that it exposes a tumor constantly to a small medication dose, which allows tumor cells to be killed while having fewer toxic effects to normal tissues. The cost and duration of therapy (options 1 (It is the least expensive form of therapy.) and 3 (It has the shortest duration of therapy for all cancer sites.)) depend on the individual situation. The side effects depend on the agents used.

The nurse is reinforcing instructions to the client on how to maintain optimal skin integrity during external radiation therapy. The nurse determines that there is a need for FURTHER teaching if the client states plans to do which action?

Keep at least 6 feet away from pregnant women, especially in the first 3 months. Rationale:External radiation treatments cause changes to the skin that increase the risk for injury. The source of radiation is external, and the client is not radioactive. Clients do not need to distance themselves from pregnant women. The client should be encouraged to eat a high-protein diet to have necessary nutrients available for tissue growth and replacement. Other common instructions are to avoid sunlight and to wash the skin with mild soap using the hand and pat dry.

A client is receiving radiation therapy to the brain because of a diagnosis of a brain tumor. Which sign/symptom of the client is noted to be a positive outcome of the radiation therapy?

Less severe headache Rationale:Radiation therapy for a brain tumor will decrease a headache, a common symptom, and this is a desired or positive outcome. Since the intracranial pressure will decrease with the shrinkage of the tumor, the headache should lessen. Radiation therapy often causes symptoms of fatigue and altered taste sensation. Clients may also experience nausea and vomiting because of the effects of the radiation on the brain's chemoreceptor trigger zone.

The nurse is assisting with conducting a health-promotion program at a local school. The nurse determines that there is a need for FURTHER teaching if a student identifies which risk factors associated with cancer? Select all that apply.

Low-fat and high-fiber diets Maintaining a normal weight CAUTION = Change in bowel/bladder A sore that does not heal Usual bleeding or discharge Thickening or lump Indigestion Obvious change in warts/moles Nagging cough Rationale:A healthy life style is one way to lower the risk of cancer. This includes maintaining a normal weight and following a low-fat, high-fiber diet. Viruses may be one of multiple agents that act to initiate carcinogenesis and that have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. High-fiber diets may reduce the risk of colon cancer. A diet that is high in fat and obesity may increase the risk of the development of certain cancers.

A client with which type of cancer is at greatest risk for experiencing the complication vena cava syndrome?

Lung cancer Rationale:Vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Lung cancer is associated with development of vena cava syndrome. 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. Blood cancers such as leukemia and multiple myeloma are not associated with tumor formation. Early stages of cancers usually are abnormal cells in tissues that then develop into tumors that enlarge with time.

A client who has been diagnosed with multiple myeloma asks the nurse about the diagnosis. The nurse bases the response on which characteristic of the disorder?

Malignant proliferation of plasma cells and tumors within the bone Rationale:Multiple myeloma is a neoplastic condition that is characterized by the abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Altered red blood cell production and altered production of lymph nodes are not characteristics of multiple myeloma. Exacerbation in the number of leukocytes describes the leukemic process.

The nurse reinforces the teaching plan for a client with a family history of breast cancer. Which teaching point would be included?

Measures to prevent and screen for cancer Rationale:Teaching reinforcement should include interventions that prevent and detect breast cancer at an early stage through screening. Monthly breast self-examination and a yearly examination by a health care professional are recommended for all adult women. It is especially important for those with a familial history of breast cancer to have a healthy lifestyle that includes a diet low in saturated fat and to maintain a healthy weight.

The nurse is assisting in caring for a client with a diagnosis of bladder cancer who recently received chemotherapy. The nurse receives a telephone call from the laboratory, which reports that the client's platelet count is 20,000 mm3. Based on this laboratory value, the nurse revises the plan of care and suggests including which interventions? Select all that apply.

Monitor skin for the presence of petechiae. Administer no intramuscular injections and limit venipunctures. Rationale:When the platelet count is decreased, the client is at risk for bleeding. A high risk of hemorrhage exists when the platelet count is less than 20,000 mm3. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is less than 10,000 mm3. The client should be assessed for signs of bleeding. Petechiae are tiny red or purple dots noted on the skin due to ruptured capillaries. Many petechiae are noted with low platelet counts. Bleeding precautions are instituted and include no intramuscular injections and limited venipunctures, using small gauge needles only.

The nurse is reviewing the laboratory results of a client who is receiving chemotherapy and notes that the platelet count is 10,000 mm3 (10 × 109/L). On the basis of this laboratory value, the nurse would perform which interventions? Select all that apply.

Monitor stools for occult blood. Instruct the client not to bend over at the waist or lift. Instruct the client to blow nose very gently without blocking either nostril. Rationale:Platelets or thrombocytes are necessary for a client to clot. A high risk of hemorrhage exists when the platelet count drops below 20,000 mm3 (20 × 109/L). Fatal central nervous system hemorrhage or massive GI hemorrhage can occur when the platelet count is less than 10,000 mm3 (10 × 109/L). The client may be treated with medications or platelet or blood transfusions to improve the platelet count. The nurse should monitor the client's stools for blood, both obvious and occult. The client should be very gentle if blowing the nose and not cause any pressure to build up in the head. The client also needs to avoid starting bleeding from epistaxis (nosebleed). The client should not bend over at the waist because this action would increase the pressure within the head and increase the risk for an intracerebral bleed. Clients with decreased immunity, which is not stated in the question, should avoid ill persons. The client should not floss the teeth and only use a soft toothbrush to avoid bleeding in the mouth.

A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is a priority in the nursing plan of care?

Monitor the client for bleeding. Rationale:Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Monitoring the temperature relates to infection, particularly if leukopenia is present. The options indicating to ambulate the client and monitor for pathological fractures are also important to the plan of care but are not directly related to thrombocytopenia.

The nurse is assisting in planning care for a client with Hodgkin's disease who is neutropenic as a result of radiation and chemotherapy. Which actions would be included in the client's plan of care? Select all that apply.

Monitor white blood cell counts daily. Ensure meticulous hand washing before caring for the client. Ask visitors with respiratory infection symptoms to not visit the client. Rationale:Low levels of neutrophils put the client at high risk for infection due to lack of immune response especially against bacteria. Clients who are undergoing radiation and chemotherapy are at increased risk of infection and should not be exposed to others with infections. Hand washing is the best means of preventing the spread of infection. Monitoring white blood cell counts will indicate the extent of neutropenia. High protein diets and electrolyte monitoring are also appropriate interventions for a client who is ill and receiving chemotherapy, but these interventions will not decrease the risk of infection.

A nursing student is assisting in caring for a client with a lung tumor; the client will be having a pneumonectomy. The nursing instructor reviews the postoperative plan of care developed by the student and suggests deleting which item from the plan?

Monitoring the closed chest tube drainage system Rationale:Pneumonectomy is the removal of the entire lung on one side and without the presence of lung tissue, a chest tube is unnecessary for the lung to reexpand. Closed chest drainage usually is not used following pneumonectomy. The serous fluid that accumulates in the empty thoracic cavity eventually consolidates. The consolidation prevents shifts of the mediastinum, heart, and remaining lung. Complete lateral positioning is avoided because the mediastinum is no longer held in place on both sides by lung tissue and extreme turning may cause mediastinal shift and compression of the remaining lung. Options 2 (Encouraging coughing and deep breathing) and 3 (Checking the surgical dressing for drainage) are general postoperative measures.

The nurse is reviewing the laboratory results of a client with bladder cancer and bone metastasis and notes that the calcium level is 15 mg/dL. The nurse would take which appropriate action?

Notify the primary health care provider. Rationale:The normal calcium level is 9 to 10.5 mg/dL. Hypercalcemia is a serum calcium level greater than 10.5 mg/dL. 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 primary health care provider must be notified. High calcium levels can lead to formation of stones in the urinary system and can lead to renal impairment. High calcium levels can affect the heart and neurological systems as well.

The nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling. The nurse would take which appropriate action?

Notify the registered nurse immediately. Rationale:When antineoplastic medications are administered via IV, great care must be taken to prevent extravasation, the condition in which the medication escapes into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site. If extravasation occurs, the RN needs to be notified at once, and the infusion will be stopped. The nurse will contact the primary health care provider. Depending on the specific medication, actions are taken to counteract the negative effects. The medication may be aspirated out, ice or warmth applied, and the area infiltrated with a neutralizing agent specific to the medication.

A nursing instructor asks a nursing student about the characteristics of Hodgkin's disease. The instructor determines that the student needs ADDITIONAL study if the student states that which is an associated characteristic?

Occurs most often in older adults Rationale:Hodgkin's disease is a disorder of young adults and primarily occurs between the ages of 20 and 40. It is considered one of the most treatable cancers. The presence of Reed-Sternberg cells on biopsy of the cervical lymph node is noted. Lymph node, spleen, and liver involvement occurs.

The nurse is reinforcing instructions to a group of female clients about breast self-examination (BSE). When would the nurse instruct the pre-menopausal client to perform this examination?

One week after menstruation begins Rationale:The BSE should be performed monthly about 7 days after the menstrual period begins. It is not recommended to perform the examination weekly; at the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.

The nurse is reinforcing instructions to a client scheduled for conization in 1 week for the treatment of microinvasive cervical cancer. The procedure has been explained by the primary health care provider, and the nurse is reviewing the complications associated with the procedure. The nurse determines that the client needs FURTHER teaching if the client states that which is a complication of this procedure?

Ovarian perforation Rationale:Conization is the removal of a cone-shaped tissue sample from the cervix done to confirm and sometimes treat cervical cancer. This procedure generally is not performed on women who desire to bear children because it can lead to incompetence of the cervix or infertility. Complications of the procedure include hemorrhage, infection, and, less frequently, cervical stenosis.

A client with cancer has undergone a total abdominal hysterectomy and has an indwelling Foley catheter in place. The nurse would expect to note which types of urinary drainage immediately following this surgery? Select all that apply.

Pale Light amber Rationale:Depending on the type of surgical technique and the amount of intravenous fluid the client receives during surgery, the urine could be pale or light amber. Purulent urine indicates infection; blood-tinged and bright red urine indicate active bleeding. These are not expected findings.

A client is tentatively diagnosed with ovarian cancer. The nurse gathers data about which LATE symptom of this disease?

Pelvic pain, anemia, and ascites Rationale:Pelvic pain, anemia, and ascites are experienced late in the disease process for ovarian cancer. Vague lower abdominal discomfort and mild digestive complaints are early symptoms. Bowel and bladder functions are also affected early in this type of cancer.

The client is hospitalized for the insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. Which is the immediate nursing action?

Pick up the implant with long-handled forceps and place into a lead container. Rationale:A lead container and long-handled forceps should be kept in the client's room at all times during internal radiation therapy. Lead is an element that has a high density and high atomic number and is used to shield persons from radiation. If dislodged, the implant must be handled carefully to limit radiation exposure to the client and all persons in the environment. If the implant becomes dislodged, the nurse should pick up the implant with long-handled forceps and place it into the lead container. The radiation safety officer of the institution should be notified. Although the PHCP needs to be notified, this is not the immediate action. The nurse cannot reinsert the implant. A radioactive implant is specifically placed inside the client to kill the cancer while limiting damage to adjacent tissues and organs. Touching the implant with gloves and flushing this down the toilet exposes the nurse and the environment to unsafe levels of radiation.

A cervical radiation implant is placed in the client for treatment of cervical cancer. Which intervention would the nurse most likely expect to note in the primary health care provider's prescriptions?

Place an indwelling urinary catheter 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. An indwelling urinary catheter is placed before the insertion of the cervical radiation implant. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. Turning the client onto her side is avoided. If the client needs to be turned, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled. All efforts are made to limit client movement to avoid displacement of the implant.

The nurse is assisting in developing a postoperative plan of care for a client following a right mastectomy. Which interventions will be included in the plan of care? Select all that apply.

Place the right arm on a pillow. Monitor the right arm for edema. Check the incision for approximation. Monitor and measure drainage in the Jackson-Pratt drain. Place a notation: "No intravenous (IVs), blood draws, or blood pressure readings in right arm." Rationale:Following mastectomy, the arm should be elevated above the level of the heart. Specific arm exercises should be encouraged. No blood pressure readings, injections, IV lines, or blood draws should be performed on the affected arm, and a sign above the bed will alert all health care personnel. The nurse would also assess the incision for approximation (incision is pulled together or intact) during dressing changes and monitor and measure drainage in the Jackson-Pratt drain. Warm compresses are NOT used in the postoperative period because this will promote edema in the arm.

The nurse would monitor for which laboratory result as indicating an adverse reaction in the client who is receiving chemotherapy?

Platelet count 20,000 mm3 Rationale:A normal platelet count ranges from 150,000 mm3 to 400,000 mm3. A platelet count of 20,000 mm3 places the client at severe risk for bleeding. All of the other values, hemoglobin, BUN, and WBC, are within normal limits.

The nurse is reviewing the laboratory results of a client receiving chemotherapy for cancer. The nurse reports which abnormal result to the primary health care provider?

Platelet count, 40,000 mm3 Normal values: Hematocrit: 37-47% female, 42-52% male platelets 150,000-400,00 WBC 5,000-10,000 Rationale:Hematological toxicity from chemotherapy occurs when there is a decreased production of blood components (RBCs, WBCs, and platelets) owing to the effects of antineoplastic agents. Platelet counts normally are 150,000 to 400,000 mm3. The values of the hematocrit, WBC count, and RBC count are within normal limits. The nurse reports this finding because this value places the client at risk for bleeding.

The nurse is caring for a client with an internal radiation implant. The nurse would observe which principles? Select all that apply.

Pregnant women are not allowed into the client's room. Wear a lead apron while delivering bedside care to the client. Rationale:A client receiving treatment for cancer with an internal radioactive implant is emitting radioactive beams, and others in the environment must take precautions to avoid injury. Pregnant persons are not allowed in the room. Nurses delivering bedside care must wear a lead apron, which will stop the radioactive beams. The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the client's room. Children younger than 16 years old and pregnant women are not allowed in the client's room. These guidelines protect individuals from radiation exposure.

The nurse is performing oral care for a newly admitted client who is undergoing chemotherapy for thyroid cancer. The nurse would take which actions while performing oral care? Select all that apply.

Provide a soft toothbrush. Check oral mucous membranes. Check for missing teeth and cavities. Rationale:The nurse should assess oral mucous membranes for sores caused by chemotherapy. A soft toothbrush should be provided to prevent irritation of the mucous membranes. Assessment of the client's dentition helps identify any limitations in diet. The nurse should use clean gloves while helping with oral hygiene. Abrasive toothpaste or alcohol-based mouthwash may cause irritation of the client's mucous membranes and bleeding.

A client with lung cancer receiving chemotherapy tells the nurse that the food on the meal tray tastes "funny." Which is the appropriate nursing intervention?

Provide oral hygiene care frequently. Rationale:Chemotherapy may cause distortion of taste. Frequent oral hygiene aids in preserving taste function. Keeping a client NPO increases nutritional risks. Antiemetics are used when nausea and vomiting are a problem. Parenteral nutrition is used when oral intake is not possible.

The nurse reviews the care plan of a client with cancer undergoing chemotherapy. The nurse notes that the client has a concern about her appearance as a result of alopecia. The nurse plans to tell the client which information about hair loss and regrowth to assist the client in coping with this possible change?

Regrown hair may have a different color and texture. Rationale:Hair loss is often temporary, and hair grows back once treatments are completed. Hair may have a different color and/or texture when it regrows. Hair loss often begins within 14 days of beginning treatment. Body hair and facial hair also are affected.

The nurse is assisting with creating a plan of care for a client with pancytopenia as a result of chemotherapy. The nurse would suggest including which in the plan of care? Select all that apply.

Restricting fresh fruits and vegetables in the diet Applying a face mask to the client if outside the client room Rationale:A client who is experiencing pancytopenia (decrease in all blood cells types: red, white, and platelets) is at high risk for infection because of significantly low immunity. The client should not eat fresh fruits and vegetables because they are at a potential for ingesting bacteria. All foods should be cooked thoroughly. The client should wear a mask when outside of the room to avoid potential infection spread from persons in the hallways. Not all visitors are restricted, but the client is protected from people with known infections. Fluids should be encouraged because dehydration increases the risk for infection. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infection.

The licensed practical nurse (LPN) is assisting the registered nurse (RN) to create a teaching plan for the client receiving an antineoplastic medication. The LPN expects which information to be included? Select all that apply.

Rinse mouth after meals and use a soft toothbrush. Maintain oral hygiene and inspect the mouth for sores daily. Consult with the primary health care provider before receiving immunizations. Rationale:Clients with cancer treated with antineoplastic medications must be aware of how to care for themselves, and it is important that client teaching is included in the care plan. Because antineoplastic medications affect the bone marrow, clients are often anemic, have lower immunity, and may be at risk for bleeding. Oral hygiene is important, and clients should inspect their mouths daily, rinse after meals, and use a soft toothbrush. The client should check with the primary health care provider (PHCP) before receiving any immunizations. The client should notify the PHCP for a low-grade temperature such as 99.5°F (39.7°C) and a sore throat. These are often associated with low white blood cell counts.

The nurse is caring for a client in the oncology unit who has developed stomatitis during chemotherapy. The nurse would plan which measure to treat this complication?

Rinse the mouth with dilute baking soda or saline solution. Rationale:Stomatitis, or mouth ulcerations, occurs with the administration of many antineoplastic medications and altered oral flora due to immunosuppression. 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 dilute baking soda or saline solution. Food and fluids are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet. The client is instructed to avoid spicy foods and foods with hard crusts or edges. The client should avoid tooth brushing and flossing when stomatitis is severe because of the risk of bleeding. Lemon and glycerin swabs may cause pain and further irritation.

The nurse reviews the laboratory results for a client diagnosed with leukemia who is receiving chemotherapy. The nurse notes that the white blood cell (WBC) count is 2000 mm3. The nurse identifies the finding as indicative of which?

Signifying leukopenia Rationale:Chemotherapy agents cause medication-induced leukopenia, and treatment focuses on this side effect. The normal WBC count is 5000 to 10,000 mm3. An elevated WBC count would most likely indicate infection.

A client who has terminal cancer has been experiencing a significant increase in pain. However, today the client is no longer complaining of pain but is quiet and isolative. Which types of therapeutic communication would the nurse employ? Select all that apply.

Sit by client's bed holding his or her hand. Reminisce with the client and share a humorous story that the client enjoys. The nurse asks: "What can I do that might make you feel more comfortable today?" The nurse asks: "I noticed you grimacing earlier when I walked in your room. Are you in pain?" The nurse states: "It must be very frustrating to be in pain and not be able to get complete relief from your pain." Rationale:Sitting by the bed and holding the client's hand is an example of silence. Reminiscing promotes active listening. Asking the client what might be done to make them more comfortable provides an offering of self and shows empathy. Asking about the lack of pain relief is a technique of empathy and offers the client an opportunity to discuss pain control. Asking the client about grimacing seeks validation. Telling the client, "Just think; you will soon be in a better place where you will not be in pain," can be viewed as offering false reassurance. It can also be viewed as making an assumption (life after death) that the client may not share.

The nurse is assisting in providing a session to community members about the risks associated with laryngeal cancer. A client indicates an understanding of the risks by listing which factors? Select all that apply.

Smoking cigarettes or cigars Drinking alcohol, especially daily Working in a dusty environment Persistent exposure to chemicals in the air Following a diet low in protein and vitamins Rationale:The top risk factors for laryngeal cancer are tobacco and alcohol use. Exposure to environmental carcinogens such as dust and chemicals, poor oral hygiene, poor diet (low protein, low vitamins), voice abuse, and chronic laryngitis are also risk factors.

The client is receiving external radiation to the neck for cancer of the larynx. The nurse monitors the client knowing that which are side/adverse effects of the external radiation? Select all that apply.

Sore throat Red and dry skin over neck Rationale:External radiation is used to treat cancer in a specific area by emission of ionizing radiation beams that destroy cancer cells and have minimal damage to the surrounding normal cells. The client receiving external radiation experiences both general side/adverse effects such as fatigue, nausea, anorexia and localized side/adverse effects in the specific area receiving radiation. A client who is receiving radiation to the larynx is most likely to experience a sore throat and dry, reddened skin in the throat area. Diarrhea or constipation occur with radiation to the gastrointestinal (GI) tract. Dyspnea may occur with lung involvement.

The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a suprapubic prostatectomy. The nurse would reinforce which discharge instruction? Select all that apply.

Take the prescribed stool softener every day. Avoid lifting objects heavier than 20 pounds for 6 weeks. Rationale:A suprapubic approach involves a lower abdominal incision to remove the prostate to treat prostate cancer. The nurse will reinforce instructions about the incision activity, medications, and when to contact the urologist. The client should take the prescribed stool softener because constipation will lead to straining and cause pain and tension on the surgical site. The client should avoid lifting more than 20 pounds for 6 weeks to avoid tension on the surgical site. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A daily fluid intake of 2 L to 2.5 L per day (unless contraindicated) should be maintained to limit clot formation and prevent infection. The incision is not on the scrotum but in the lower abdominal area. Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery and do not need to be reported.

The nurse is reinforcing instructions to a client on performing a testicular self-examination (TSE). Which instructions would the nurse provide to the client? Select all that apply.

The best time for the examination is after a shower. Set up a schedule of performing TSE on the same day each month. Rationale:The TSE is recommended after a warm bath or shower when the scrotal skin is relaxed. The client should set up a schedule of performing TSE the same day each month in order not to forget. The client should stand to examine the testicles. Using both hands, with the fingers under the scrotum and the thumbs on top, the client should gently roll the testicles, feeling for any lumps. The TSE should be performed monthly.

The nurse is caring for a client who will have insertion of an internal cervical radiation implant. Which interventions would the nurse review with the client to prepare her for this procedure? Select all that apply.

The client's activity will be bed rest. The client will have an indwelling urinary catheter placed. Caregivers will wear lead shields while caring for the client. Rationale:When a client has an internal cervical radioactive implant, precautions are planned to protect those around the client and to keep the implant in place and not harm the client. The client will be placed on bed rest and will have an indwelling urinary catheter in place, and caregivers will wear lead shields for protection. Clients are not normally administered stool softeners because of the risk of loose stools, which could potentially lead to dislodgement of the implant. Clients are log rolled so as not to move the implant. ROM exercises are not done.

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?

The development of a vesicovaginal fistula Rationale:A vesicovaginal fistula is a fistula connection that occurs between the bladder and the 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. Rupture of the bladder would cause pain. Stress is experienced in other ways. Altered perineal sensation would not be as specific as voiding through the vagina.

When inspecting the stoma of a client following an ureterostomy 6 hours ago, the nurse notes that the stoma appears pale in color. Which interpretation does the nurse make based on this finding?

The vascular supply to the stoma is insufficient. Rationale:Following ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate vascular supply. This not a normal postoperative appearance. No data are available to determine whether the client is experiencing a fluid volume excess or a fluid volume deficit. A dry stoma may indicate body fluid deficit. Any sign of darkness or duskiness in the stoma may mean loss of vascular supply and must be corrected immediately or necrosis can occur.

The nurse is preparing a client with a bowel tumor for surgery. The primary health care provider has informed the client that the surgery is palliative in the treatment of the tumor. Which rationale is the reason to perform this type of surgery?

To reduce pain Rationale:Palliative surgery that can benefit the client with cancer and improve quality of life includes procedures that reduce symptoms including pain, relieve airway obstructions, relieve obstruction in the gastrointestinal and urinary tracts, relieve pressure on the brain and spinal cord, and prevent hemorrhage. Palliative surgery is not curative, does not reduce risk for metastasis, or improve appearance (cosmetic surgery).

The nurse reinforces instructions to the client about breast self-examination (BSE). The nurse instructs the client to lie down and examine the left breast. Which is the correct area for placing a pillow when examining the left breast?

Under the left 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 left breast is to be examined, the pillow would be placed under the left shoulder

A client with liver cancer who is receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter, especially meats. The nurse would instruct the client to eat which foods instead of meat? Select all that apply.

Yogurt Custard Rationale:Chemotherapy may cause distortion of taste. Frequently, beef and pork are reported to taste bitter or metallic. The nurse can promote client nutrition by assisting the client in choosing alternative sources of protein in the diet. Yogurt and custard are protein sources that may be more palatable. Potatoes, cantaloupe, and potato chips are not good sources of protein.