Unit 9

A patient with a diagnosis of renal cell carcinoma is being treated with chemotherapy. During a previous round of chemotherapy, the patient's tumor responded well to treatment but the chemotherapy caused intense nausea and vomiting. How should the patient's potential nausea and vomiting be addressed during this current round of treatment?

Administer antiemetics in anticipation of the patient's nausea. Explanation: The prevention of chemotherapy-induced nausea and vomiting is a priority. It is inappropriate to reject pharmacological treatments or to wait until the patient experiences nausea and/or vomiting before providing medication.

The nurse is teaching a client about cancer prevention. The nurse evaluates teaching as most effective when a female client states that she will

Use sunscreen when outdoors. Explanation: Use of sunscreens play a role in the amount of exposure to ultraviolet light. Even decreasing the use of tobacco still exposes a person to risk of cancer. The American Cancer Society recommends adults to engage in at least 30 minutes of moderate to vigorous physical activity on 5 or more days each week. It is recommended to obtain a cancer history from at least three generations.

The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting:

Severity of the pain as judged by the patient Explanation: The patient's perception of pain severity should always be the primary consideration. It forms the baseline for all management.

A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect?

Addiction Explanation: Addiction is a behavioral pattern of substance use characterized by a compulsion to take the substance primarily to experience its psychic effects. Placebo effect is analgesia that results from the expectation that a substance will work, not from the actual substance itself. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued. Tolerance occurs when a client who has been taking opioids becomes less sensitive to their analgesic properties.

The nurse is obtaining data regarding medications the client is taking on a regular basis. The client states he is taking duloxetine, an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving?

Adjuvant drug therapy Explanation: Adjuvant drugs are medications that are ordinarily administered for reasons other than treating pain. Duloxetine is used to treat depression but is being used for neuropathic pain for this client

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point?

At the same time the first patch is applied Explanation: Because it takes 12 to 18 hours for the fentanyl concentrations to increase gradually from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied. The skin must be clean and dry before applying the patch; no shower is required. Respiratory assessment must be conducted before applying the fentanyl patch.

The nurse caring for a 74-year-old man who has just returned to the surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment, in which the patient stated that he has "gotten confused" in the past when he takes pain medications. The nurse should recognize which of the following principles of pain management among older adults?

The elderly may require lower doses of medication and are easily confused with new medications. Explanation: The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and therefore the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors, like environment. The elderly may have altered absorption and metabolism, but the use of lower-dose opiates is encouraged for pain. Confusion following surgery is never normal. With the elderly, give medication at a low dose and slowly increase the dose until the pain is managed.

A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem?

The patient requests that her family bring her makeup and wig. Explanation: Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they don't assess improved body image and self-esteem.

The client has suffered an injury to his right leg and is reporting pain at the level of "5" on a scale of 0 to 10. The client has a history of peripheral arterial disease. The client requests nonpharmacologic interventions. What interventions are appropriate for the nurse to perform? Select all that apply.

massages the client's back and shoulders teaches the client to perform slow, rhythmic breathing turns on the television to a show the client asks to watch Explanation: Nonpharmacological interventions that promote comfort include a massage even to an unaffected area, relaxation techniques as in counted breathing, and distraction as in watching the television. Ice is not applied to an area with impaired circulation. Macrobiotic diet is an alternative therapy that may be harmful.

A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication?

tolerance Explanation: Tolerance is a condition in which a client needs larger doses of a drug to achieve the same effect as when first administered; it may not develop until an opioid drug is used regularly for 4 weeks or more. Activation of NMDA receptors is believed to decrease the effect of opioids, resulting in the need for higher doses to achieve a therapeutic effect. The development of tolerance is not an indication of addiction; rather, the client's request for pain-relieving drugs more often is a consequence of poor pain control. Addiction is a repetitive pattern of drug seeking and drug use to satisfy a craving for a drug's mind-altering or mood-altering effects. Although opioid drugs can result in addiction, there is very little evidence that those who require narcotics for legitimate pain actually become addicted. An allergic reaction to a drug could present many symptoms, such as a rash, hives, or difficulty breathing, but it would not result in a client requesting increased medication. Most prescription drugs are manufactured using strict quality control standards, so poor quality control is not likely to be a reason for the client's request for increased medication.

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond?

"You may experience progressive deterioration in all voluntary muscles." Explanation: The nurse should tell the client that muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly progressive, relatively benign form of muscular dystrophy; it usually arises before age 10.

Which of the following points would be most important for the nurse to stress when developing a patient-teaching plan for a patient receiving antineoplastic therapy?

- The importance of keeping the head covered at extremes of temperature. - The need to use barrier contraceptives because of the risk of serious fetal effects. - The importance of avoiding exposure to infection because the ability to heal or to fight infection is impaired. - The importance of avoiding digging in the dirt without protective coverings because of the many pathogens that live in the dirt that could cause infection. - The importance of taking periodic rest periods during the day because you will feel tired when your red blood cell count falls.

An asymptomatic client who is worried about developing breast cancer due to the fact that it runs in her family asks the nurse if she could have a mammogram to see if she has any lumps. The nurse informs the client that a tumor usually is undetectable until it has doubled 30 times and contains more than 1 billion cells. This means that at this point it measures approximately which size?

1 cm Explanation: Using conventional radiographic methods, a tumor usually is undetectable until it has doubled 30 times and contains more than 1 billion cells. At this point it is approximately 1 cm in size. A tumor that measures anything over 1 cm including 3 cm, 4 cm, and 5 cm would definitely be detectable using radiography

A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 132 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.

600 Explanation: First, change the client's weight in pounds to kilograms by dividing the weight by 2.2 (2.2 pounds = 1 kg). The client's weight is 60 kg. Next, set up a proportion: 10/1 = x/60; cross multiply and solve for x, which is 600.

A nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching?

7 to 14 days Explanation: Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.

A client with cerebral metastasis suddenly experiences a seizure for which phenytoin 10 mg/kg intravenously is ordered as an initial loading dose. The client weighs 165 pounds. How many milligrams of phenytoin should the client receive? Enter the number ONLY.

750 Explanation: First, change the client's weight in pounds to kilograms by dividing the weight by 2.2 (2.2 pounds = 1 kg). The client's weight is 75 kg. Next, set up a proportion: 10/1 = x/75; cross multiply and solve for x, which is 750.

Which client of a primary care physician would not require extra screening for cancer?

A 38-year-old female with Down syndrome and congenital scoliosis Explanation: While a family history of cancer, immunosuppression, and poor diet are all associated with cancer, congenital and chromosomal abnormalities are not noted to represent an increased risk.

The nurse on an oncology unit is providing care for several clients with cancer, most of whom are receiving chemotherapy. What client should the nurse prioritize?

A client with hairy cell leukemia receiving pentostatin whose urine output is 35 mL over the past 12 hours Explanation: Oliguria is suggestive of renal failure and requires prompt intervention. It would be prioritized over nausea and mucositis, even though the nurse should address both of these problems. Similarly, the care team should address the client's drop in hemoglobin but it is not so precipitous that it would be more time-dependent than a client with possible acute renal failure.

The nurse is orienting a student to the oncology setting. Which characteristic does the student identify as one that is representative of a benign tumor?

A fibrous capsule Explanation: Because benign tumors have slow cell replication and growth, they develop a surrounding rim of compressed connective tissue called a fibrous capsule. Benign tumors encapsulate and are incapable of distant metastasis. Benign tumors have mature, differentiated cells but they have lost the ability to suppress cell proliferation.

A biopsy of a client's liver has been taken because there is suspicion that his lung cancer may have metastasized. The results confirm that there are cancerous cells in the client's liver and the oncologist has estimated a high growth fraction in the sample. The nurse should draw what implication from this finding?

A large proportion of the cells in the sample are actively dividing. Explanation: The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. A high growth fraction represents a large proportion of growing cells, but does not necessarily mean that every cell is dividing. Stem cells would not be present in a sample from this location. Growth fraction does not imply a particular size of the cells.

A patient with amyotrophic lateral sclerosis (ALS) wishes to use his Medicare Hospice Benefit in an effort to maximize his quality of life prior to death. What criterion will determine whether the patient qualifies for this benefit?

A life expectancy of less than 6 months Explanation: According to Medicare, the patient who wishes to use his or her Medicare Hospice Benefit must be certified by a health care provider as terminally ill, with a life expectancy of 6 months or less if the disease follows its natural course. Exhaustion of treatment options, copayment, and a lack of social support are not criteria used to determine qualification

A patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomiting. What is the best response by the nurse?

"We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." Explanation: Reassure patients that nausea and vomiting can be relieved with antiemetic drug therapy and emphasize that they should request these agents when needed.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross?

Anger Explanation: Anger is the second stage and is exhibited by statement similar to "Why me?" Denial occurs when the person refuses to believe certain information. Bargaining is an attempt to postpone death. During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close.

A child is prescribed an anthracycline drug. The nurse would teach the parents to observe for signs and symptoms of what adverse effect?

Cardiotoxicity Explanation: Children who receive an anthracycline drug (e.g., doxorubicin) are at increased risk of developing cardiotoxic effects (e.g., heart failure) during treatment or after receiving the drug. Efforts to reduce cardiotoxicity include using alternative drugs when effective, giving smaller cumulative doses of anthracycline drug, and observing clients closely so that early manifestations can be recognized and treated before heart failure occurs.

The nurse is caring for a dying client in a hospice setting. The family is unsure whether to go home for rest or spend the night with the client. Which body system would the nurse assess to provide the first data on decline?

Cardiovascular system Explanation: The key word is "first". Failing of cardiac functioning is one of the first signs that a condition is worsening. Symptoms within the other systems can also denote deterioration over time.

An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient's chemotherapy. Which cancerous cell is most susceptible to the effects of chemotherapeutic drugs?

Cells that have a rapid mitotic rate Explanation: Cells that have a short generation time or rapid mitotic rate are most sensitive to antineoplastic agents. All cells (both cancerous and noncancerous) have a blood supply. A lack of contact inhibition is characteristic of cancer, but this is not associated with susceptibility to chemotherapeutic drugs.

In which location are most brain angiomas located?

Cerebellum Explanation: Brain angiomas occur most often in the cerebellum. Most brain angiomas do not occur in the hypothalamus, thalamus, or brainstem (midbrain, pons, medulla).

A client comes to the clinic for evaluation because of complaints of dizziness and difficulty walking. Further assessment reveals a staggering gait, marked muscle incoordination, and nystagmus. A brain tumor is suspected. Based on the client's assessment findings, the nurse would suspect that the tumor is located in which area of the brain?

Cerebellum Explanation: Findings such as ataxic or staggering gait, dizziness, marked muscle incoordination, and nystagmus suggest a cerebellar tumor. A frontal lobe tumor frequently produces personality, emotional, and behavioral changes. A tumor in the motor cortex produces seizure-like movements localized on one side of the body. Occipital lobe tumors produce visual manifestations.

Which of the following diagnostic studies provides visualization of cerebral blood vessels?

Cerebral angiography Explanation: Cerebral angiography provides visualization of cerebral blood vessels and can localize most cerebral trauma. A PET scan measures the brain's activity and is useful in differentiating tumor from scar tissue or radiation necrosis. Cytologic studies of the cerebral spinal fluid (CSF) may be performed to detect malignant cells because central nervous system tumors can shed cells into the CSF. Computer-assisted stereotactic biopsy is being used to diagnose deep-seated brain tumors.

A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc?

Have the client lie on the back and lift the leg, keeping it straight. Explanation: A client who can lie on the back and raise a leg in a straight position will have pain radiating into the leg if there is a herniated lumbar disc. This action stretches the sciatic nerve. The client may also have muscle weakness and decreased tendon reflexes and sensory loss. The client should still be able to walk, and have bowel movements, so this assessment will not assist the nurse to confirm the diagnosis. Pain on ambulation is also not specific to this condition.

The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.

Egg white omelet with spinach and mushrooms Steamed broccoli and carrots Turkey breast on whole wheat bread Explanation: Foods high in fat and those that are smoked or preserved with salt or nitrates are associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy low fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad can be a healthy selection but Caesar salads contain much fat from the dressing and addition of cheeses and fried chicken. Salmon that is not smoked would be a good selection. Quiche usually contains high-fat milk, crème, eggs, and cheese.

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:

Encourage fluid intake, if possible, to dilute the urine. Explanation: To prevent renal damage, it is helpful to dilute the urine by increasing fluids as tolerated.

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

Encourage the family members to express their feelings and listen to them in their frank communication. Explanation: Family members usually find it difficult to communicate frankly with a dying person. By encouraging family members to express their feelings and listening to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying patient. It is not advisable for the nurse to encourage conversations on the impending death of the patient. Being a silent observer or encouraging the family members to spend time with the dying patient may not help the family members to express their feelings.

A client with an incurable brain tumor is experiencing nausea and vomiting and has little interest in eating. His family states, "We don't know how to help him." Which of the following would be appropriate for the nurse to suggest to help improve the client's nutritional intake? Select all that apply.

Ensure that the client is free of pain for meals. Plan meals for times when the client is rested. Provide the client with foods that he likes. Explanation: Suggestions to improve nutrition include making sure that the client is comfortable, free of pain, and rested. This may require family members to adjust meal times. Additionally, they should eliminate offensive sights, sounds, and odors. Therefore, placing the client near sites of meal preparation may be too overwhelming. If the client has difficulty with or shows disinterest in usual foods, the family should offer foods that the client prefers, rather than attempting to get the client to eat as previously. If the client shows marked deterioration, then some other form of nutritional support such as a feeding tube or parenteral nutrition may be indicated, but only if this measure is consistent with the client's choices for care.

A client has recently been diagnosed with an acoustic neuroma. The nurse helps the client understand that:

Hearing loss usually occurs. Explanation: An acoustic neuroma is a benign tumor of the eighth cranial nerve. About 50% can be treated with surgery. Hearing loss always occurs. Compression on the fifth cranial nerve can also cause facial paresthesia.

A 26-year-old man who survived childhood acute lymphocytic leukemia (ALL), one of the most common childhood cancers, now complains of weakness, fatigue, and shortness of breath. His treatment for ALL likely included anthracyclines. What is the most likely cause of his symptoms?

Heart failure resulting from childhood chemotherapy Explanation: The client's symptoms resemble those of congestive heart failure. The anthracyclines, such as doxorubicin and daunorubicin, are associated with risk for developing cardiomyopathy and heart failure.

A nurse on the oncology floor reads a client's chart and sees that the client was treated for an adenocarcinoma. What type of tissue composes this tumor?

Glandular epithelium Explanation: The term "adenocarcinoma" denotes a malignancy of the glandular epithelium. CNS cancers usually begin with "neuro-" and there is no particular term used to denote a stem cell cancer. There are varied terms used to describe cancers of the connective tissue, depending on the tissue type.

A client asks the nurse how the oncologist will determine if the medication to treat his cancer is working. Which model focuses on tumor growth and is used for studying the effects of medications on cancer cells?

Gompertzian Explanation: The nurse should respond that the Gompertzian model is often used to determine if a client's medication to treat a cancer is working.

A 37-year-old mother of three has just been diagnosed with a grade I meningioma. As part of patient education, the nurse tells the patient that:

Growth is slow and symptoms are caused by compression rather than tissue invasion. Explanation: A meningioma is benign, encapsulated, and slow-growing. Sometimes the patient has no symptoms because of the slow-growing nature of the tumor.

A client has undergone a screening colonoscopy. The doctor removed several polyps that were sent to pathology and identified as benign. Select the best explanation of a polyp.

Growth that projects from a mucosal surface Explanation: A polyp is a growth that projects from a mucosal surface, such as the intestine. Papillomas are benign microscopic or macroscopic fingerlike projections that grow on any surface. A benign epithelial neoplasm of glandular tissue is called an adenoma, and a benign tumor arising in fibrous tissue is called a fibroma.

While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply.

Gurgling as the client breathes through the mouth Decrease in amount of urine produced Refusal to ingest food or fluids Explanation: As death approaches, a client typically has secretions that collect in the back of the throat and rattle or gurgle as the client breathes through the mouth. Breathing may become irregular with periods of no breathing. Urine output may decrease in amount and frequency, and loss of bladder and bowel control may occur. The person approaching death shows less interest in eating and drinking; for many, refusal of food is an indicator that they are ready to die. Vision and hearing may be somewhat impaired and speech may be difficult to understand.

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?

Ham and bacon Explanation: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats. Nitrates are added to cured meats, such as ham and bacon.

For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death?

Increased restlessness Explanation: As the oxygen supply to the brain decreases, the client may become restless. As the body weakens, the client will sleep more and begin to detach from the environment. For many clients, refusal of food is an indication that they are ready to die. Based on decreased intake, urinary output generally decreases in amount and frequency.

Chemotherapeutic agents have which effect associated with the renal system?

Increased uric acid excretion Explanation: Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Urinary excretion of uric acid increases with the use of chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis?

Ineffective airway clearance Explanation: In parkinsonian crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, the nursing diagnosis of Ineffective airway clearance takes the highest priority. Although Imbalanced nutrition: Less than body requirements, Impaired urinary elimination, and Risk for injury are also appropriate nursing diagnoses, they aren't immediately life-threatening.

How can a nurse best prevent tissue damage caused by an antineoplastic extravasation?

Inspect the site frequently for redness or swelling Explanation: Site inspection is a major intervention for preventing extravasation. Distal veins should be used. Small veins in the hand or wrist should be avoided. An infusion pump should be avoided because it can continue to administer the drug under pressure, leading to severe extravasation

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy?

It removes a wedge of tissue for diagnosis. Explanation: The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen?

It targets normal body cells as well as cancer cells. Explanation: Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.

Which of the following nursing interventions should a nurse perform to promote the dignity and self-esteem of a dying client?

Keep the client clean and well groomed. Explanation: A nurse should keep the client clean, well groomed, and free of unpleasant odors to promote his or her dignity and self-esteem. Although sharing emotional pain is an essential component of care for dying clients, it will not promote their dignity and self-esteem. Communicating hopefulness helps sustain hope in dying clients. Helping the client live according to his or her wishes is a feature of hospice care.

A male client who has undergone a cervical discectomy is being discharged with a cervical collar. Which of the following would be most appropriate to include the client's discharge plan?

Keeping the head in a neutral position Explanation: After a cervical discectomy, the client typically wears a cervical collar. The client should be instructed to keep his head in a neutral position and wear the collar at all times unless the physician has instructed otherwise. The front part of the collar is removed for shaving and the neck should be kept still while the collar is open or off.

The nurse has just completed a presentation to a group of senior citizens regarding health promotion and screening activities for the detection of cancer. The nurse realizes further teaching is necessary when a participant identifies a definitive test is available for which type of cancer?

Kidney cancer Explanation: Currently, kidney cancer does not have a definitive screening mechanism. Cervical cancer is screened for with a Papanicolaou test, whereas breast cancer can be screened with a self-examination or mammography. Prostate cancer is screened with prostate-specific antigen (PSA) testing.

The nurse is providing postoperative care for a client who just underwent surgery to remove a metastatic intramedullary tumor. On postoperative day 3, the client states, "I am really looking forward to going running again, it had become too difficult because of the loss of feeling in my feet." Which should the nurse address in the client's care plan?

Knowledge deficit Explanation: Clients with extensive neurologic deficits before surgery usually do not make significant functional recovery, even after successful tumor removal. In this case, the client had already developed bilateral sensory loss in the lower extremities indicating the fairly progressed impact of the tumor on the client's functional ability. The client's statement reflects a knowledge deficit and it is a priority to provide information regarding the possibility that lower extremity sensation may not return. Although body image disturbance and anxiety may be identified and addressed. This would occur after the client demonstrates an accurate understanding of loss of functional capabilities as a result of the progressed tumor. Ensuring the client understands the extent of functional loss due to the impact of the tumor is a priority. The client does not demonstrate impaired cognition.

A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast without displaying many signs/symptoms. The nurse responds that malignant tumors affect area tissues by:

Liberating enzymes and toxins Explanation: Malignant tumors affect area tissues by liberating enzymes and toxins that destroy tumor tissue and normal tissue. In addition, the malignant cells compress area vessels, causing ischemia and tissue necrosis. The high metabolic rate of tumor growth causes the tumor to deprive the normal tissues of essential nutrients.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?

Liver Explanation: The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?

Logroll the client from side to side. Explanation: Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area. The nurse should encourage ROM exercises to maintain muscle strength. Because of pressure on the operative area, having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations.

A nursing student who is studying cancer cells identifies which of the following to be the best definition of anaplasia?

Loss of cell differentiation in cancerous tissue Explanation: The term "anaplasia" is the loss of cell differentiation in cancerous tissue. Rapid proliferation of cancer cells refers to a rapid increase in number of cells, while decreased proliferation is a decrease in the growth or decrease in the number of cells. An increase in cell differentiation refers to the process by which a less specialized cell becomes a more specialized cell type. This is not what happens during anaplasia.

The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient?

Older people experience reduced sensory perception. Explanation: Pain affects individuals of every age, sex, race, and socioeconomic class

The nurse cares for a client with Huntington disease. What intervention is a priority for safe care?

Protecting the client from falls Explanation: The client with Huntington disease has a risk for injury from falls and skin breakdown. Protecting the client from falls is a priority for safe care. Electrolyte and cholesterol monitoring is not a priority for this condition. Range-of-motion exercises will not protect the client from injuries.

An oncology nurse is reviewing the medication administration record of a client being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the client has been ordered a cytoprotective agent. What is the goal of treatment with this agent?

Reduce the incidence or severity of adverse drug effects. Explanation: Cytoprotectant agents reduce the adverse effects of cytotoxic drugs, some of which can be severe, debilitating, or life threatening. Cytoprotectant drugs do not potentiate chemotherapy, protect the client from the effects of cancer, or buffer cytotoxins.

A patient is scheduled for cryoablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse?

The surgeon is going to use liquid nitrogen to freeze the area." Explanation: Cryoablation is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers. Chemosurgery is the use of medication. Laser surgery is the use of a laser. Radiofrequency ablation is the use of thermal energy.

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a client. Which characteristic is associated with this client's neoplasm?

The tumor will grow by expansion and is likely encapsulated. Explanation: Benign neoplasms typically grow by expansion rather than invasion. As well, they are usually contained within a fibrous capsule. Malignant tumors are associated with undifferentiated cells, metastasis, and infiltration of surrounding tissue.

A nurse is performing discharge teaching with a client who will soon return home. The client will continue taking imatinib for the foreseeable future, and the nurse is teaching the client about the safe administration of this drug. How should the nurse instruct the client to take imatinib?

With food and a large glass of water Explanation: Imatinib should be taken with food and a large glass of water.

Which statement, made by the nurse, can be most helpful when caring for a client in the third stage of Kubler-Ross' emotional reactions to dying?

"I understand that it would be wonderful to see your daughter's graduation." Explanation: The third stage of Elisabeth Kubler-Ross' series of reactions is bargaining. Confirming the intention to live to a certain time is common in this stage. Reviewing laboratory and diagnostic tests occurs in the first stage, denial. Talking about anger occurs in the second stage, anger. Living for the day is an idea which occurs in the final stage, acceptance.

A nursing student who is studying cancer correctly identifies which of the following as a method for classifying cancers?

Grading Explanation: A basic method of classifying cancers is grading. Faces scale is used as a pain scale with children. A point system is not useful in classifying cancers and there is no such "levels of seriousness" used in regards to cancer

Which term is used to describe the personal feelings that accompany an anticipated or actual loss?

Grief Explanation: Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.

The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted:

Growth factors Explanation: Many tumors secrete growth factors, which trigger and regulate the angiogenesis process. Tumor cells express various cell surface attachment factors, for anchoring. Tumor cells secrete proteolytic enzymes to degrade the basement membrane and migrate into surrounding tissue. Cancer cells may produce procoagulant materials that affect clotting mechanisms.

A patient with a brain tumor is complaining of headaches that are worse in the morning. What does the nurse know could be the reason for the morning headaches?

Increased intracranial pressure Explanation: Headache, although not always present, is most common in the early morning and is made worse by coughing, straining, or sudden movement. It is thought to be caused by the tumor invading, compressing, or distorting the pain-sensitive structures or by edema that accompanies the tumor, leading to increased intracranial pressure.

A client who has just recently been diagnosed with cancer asks the nurse what tumor markers are. Which answer would be the nurse's best response?

Markers are antigens expressed on the surface of tumor cells. Explanation: Tumor markers are antigens expressed on the surface of tumor cells or substances released from normal cells in response to the presence of a tumor.

Which term best describes a living will?

Medical directive Explanation: A living will is a type of advance medical directive in which the individual, who is of sound mind, documents treatment preferences. A proxy directive and health care power of attorney are other names for a durable power of attorney for health care, in which one individual is appointed and authorized to make medical decisions on behalf of another person when that person is no longer able to speak for him or herself.

Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?

Mourning Explanation: Mourning refers to individual, family, group, and cultural expressions of grief and associated behaviors. Grief refers to the personal feelings that accompany an anticipated or actual loss. Bereavement refers to the period of time during which mourning takes place. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.

The daughter of a patient with Huntington's disease asks the nurse what the risk is of her inheriting the disease. What is the best response by the nurse?

"If one parent has the disorder, there is a 50% chance that you will inherit the disease." Explanation: Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. The disease affects approximately 1 in 10,000 men or women of all races at midlife. It is transmitted as an autosomal dominant genetic disorder; therefore, each child of a parent with Huntington disease has a 50% risk of inheriting the disorder (Ha & Fung, 2012).

A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize?

Risk for Infection related to suppressed bone marrow function Explanation: Because doxorubicin suppresses bone marrow function, the patient is at risk of leukopenia and subsequent infection. Impaired skin integrity is less likely and airway clearance will not normally be affected. Nutritional deficit, not excess, is common.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?

Serum potassium level of 2.6 mEq/L Explanation: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

Which substance reduces the transmission of pain?

Endorphins Explanation: Chemicals that reduce or inhibit the transmission of perception of pain include endorphins and enkephalin, which are morphinelike endogenous neurotransmitters . Acetylcholine, serotonin, and substance P are chemicals that increase the transmission of pain.

The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully?

Older people are more sensitive to drugs. Explanation: Older adults are often sensitive to the effects of the adjuvant analgesic agents that produce sedation and other CNS effects, such as antidepressants and anticonvulsants. Therapy should be initiated with low doses, and titration should proceed slowly with systematic assessment of patient response

Cancer treatment usually occurs in several different treatment phases. In assessing the appropriateness of another round of chemotherapy for a particular patient the nurse would evaluate which of the following as most important?

Bone marrow function

The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to

Educate the client that this goal may not be achievable. Explanation: The client's goal of complete elimination of pain may be unrealistic. The nurse needs to first teach the client about setting an achievable goal. The nurse will plan to use a combination of pharmacologic and nonpharmacologic interventions for pain relief. The nurse may need to notify the surgeon of the client's goal of "0" for pain relief. The nurse does not ensure large doses of opioids are prescribed for the client. Many factors go into the prescription of medication for pain relief, including the client's response to the medication.

Which of the following would be inconsistent with a normal grief reaction?

Elation Explanation: Denial, sadness, anger, fear, and anxiety are normal grief reactions in people with life-threatening illness and those close to them. Elation would not be a normal grief reaction.

The nurse understands that when administering cisplatin, the drug has a high potential for causing severe nausea and vomiting. What term is used to describe this group of antineoplastic drug?

Emetogenic Explanation: Cisplatin belongs to a group of antineoplastic drugs called emetogenics, which have high potential for causing severe nausea and vomiting.

Nursing students are reviewing the various types of brain tumors. The students demonstrate understanding of the material when they identify which of the following as the most common type?

Gliomas Explanation: Gliomas are the most common type of intracerebral brain tumor. Meningiomas account for approximately 15% of all primary brain tumors. Pituitary adenomas represent approximately 10% to 15% of all brain tumors. Acoustic neuromas are less common.

While studying cancer, nursing students learn about the process by which cancer-causing agents cause normal cells to become cancerous. This process is a multi-step mechanism that can be divided into three stages, which include which of the following? Select all that apply.

Initiation Promotion Progression Explanation: The process by which carcinogenic agents cause normal cells to become cancerous is a mechanism that are divided into three stages: initiation, promotion, and progression.

Which of the following is a characteristic of a malignant tumor?

It gains access to the blood and lymphatic channels. Explanation: By this mechanism, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.

A male patient has been on long-term bicalutamide therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor:

Liver function Explanation: It is important for the nurse to monitor the client's liver function closely if the client is on prolonged therapy with an antiandrogenic agent. Adverse effects of the therapy include gynecomastia, diarrhea, hot flashes, breast pain, impotence, loss of libido, and abnormal liver functions. Monitoring of blood counts, an annual pap smear, and regular visual function tests are advised for clients undergoing tamoxifen therapy.

Which diagnostic is most commonly used for spinal cord compression?

Magnetic resonance imaging (MRI) Explanation: MRI is the most commonly used diagnostic tool, detecting epidural spinal cord compression and metastases.

Based on the most common concern of a dying patient, the hospice nurse should:

Administer pain medication on a schedule that prevents pain from intensifying. Explanation: Pain management is the most common concern for the dying patient. Medication should be given on a PRN schedule that keeps the patient comfortable.

Cancer prognosis has improved most dramatically when treatment plans include which of the following?

Multiple types of treatment Explanation: Treatment plans that use more than one type of therapy, often in combination, are providing cures for a number of cancers that a few decades ago had a poor prognosis, and in turn are increasing the life expectancy. The remaining options can be components of a multi-pronged treatment plan

The nurse caring for a lung cancer client with metastasis to the brain suspects the client has developed a paraneoplastic syndrome known as Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion. Which laboratory result in this client who has gained 3 lb in a day would alert the nurse to the possibility of SIADH?

Serum sodium of 115 mEq/L (115 mmol/L) Explanation: SIADH is the principal cause of hyponatremia in malignant disease. It may be caused by oat cell carcinoma of the lung and certain other malignant tumors or due to the tumor producing vasopressin. The other lab values, K+, BUN, and hematocrit are all within normal adult ranges.

A patient is to start with chemotherapy. The patient is worried about going bald in the course of the treatment. How can the nurse assist the patient in being comfortable with his or her body image?

Suggest the use of a wig or cap. Explanation: The nurse can assist the patient in being comfortable with his or her body image by suggesting that the patient use a wig or cap until the hair grows back. The nurse should forewarn about hair loss to prepare the patient for the outcome of the treatment. The nurse should explain that hair preserves body heat and loss of hair is not life-threatening, and this will put the patient at ease during treatment.

Corticosteroids are used in the management of brain tumors to

reduce cerebral edema. Explanation: Corticosteroids may be used before and after treatment to reduce cerebral edema and promote a smoother, more rapid recovery. Corticosteroids do not prevent extension of the tumor or facilitate regeneration of neurons. Stereotactic procedures identify the precise location of the tumor.

Hair loss, or alopecia, is an adverse effect of many antineoplastic agents. If a client is receiving a drug that usually causes alopecia, it is important that the nurse do which of the following?

- Warn the patient that alopecia will occur. - Encourage the patient to arrange for an appropriate head covering at extremes of temperature. - Encourage the patient to arrange for a wig or other head covering before the hair loss occurs. Advise the patient that people will stare and can be rude when hair loss occurs.

The nursing student studying about cancer says the following: "A neoplasm, benign or malignant, represents a new growth." This statement is considered to be which of the following?

True Explanation: A neoplasm, benign or malignant, represents new growth. However, benign and malignant tumors differ in terms of cell characteristics, manner of growth, rate of growth, potential for metastasis, ability to produce generalized effects, tendency to cause tissue destruction, and capacity to cause death.

One of the functions of nursing care of the terminally ill is to support the client and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? Select all that apply.

Try to appreciate and understand the illness from the client's perspective. Assist clients with performing a life review. Provide interventions that facilitate end-of-life closure. Explanation: Nurses are responsible for educating clients about their illness and for supporting them as they adapt to life with the illness. Nurses can assist clients and families with life review, values clarification, treatment decision making, and end-of-life closure. The only way to do this effectively is to try to appreciate and understand the illness from the client's perspective. The nurse's personal experiences should not normally be included and a cure is often not a realistic hope.

A nurse is caring for a client with pain. What should the nurse monitor for when administering intravenous acetaminophen?

hepatotoxicity Explanation: The nurse will need to monitor the client receiving acetaminophen for hepatotoxicity. Intravenous acetaminophen should not cause renal toxicity, bleeding, and gastrointestinal effects.

According to the Joint Commission, which of the following is a focus of assessment related to quality of pain?

Description in the client's own words Explanation: The focus of pain assessment is the description in the client's own words.

A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced how often?

Every 48-72 hours Explanation: Fentanyl patches should be replaced every 48-72 hours, depending on client response. The other time frames are incorrect.

A female client will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the client's drug regimen and the client has asked about the potential side effects of treatment. How should the nurse best respond?

"Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells." Explanation: Targeted therapies are generally considered to be less toxic than traditional chemotherapy drugs. However, adverse reactions to targeted therapies can occur such as severe skin reactions, GI toxicities, skin reactions, and thrombosis.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching?

"I'm worried I'll expose my family members to radiation." Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?

"It will enable the patient to remain home if that is what is desired." Explanation: The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life. The patient and family make up the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.

The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication and it doesn't seem to affect him. What is the nurse's best response?

"Over time, you become more tolerant of the drug." Explanation: Over time, the patient is likely to become more tolerant of the dosage. There is little evidence that patients with cancer become addicted to the opioid medications. Patients do not become immune to the effects of the drug, and the body does not absorb less of the drug because of the cancer.

You are caring for a client who has just been told that they have stage IV colon cancer. The client asks you what "stage IV" means. What would be your best response?

"Stage IV means that the cancer has spread to other organs of the body." Explanation: Stage IV: Cancer has invaded or metastasized to other organs of the body. Options A and B are part of grading tumors not staging them. Option C is incorrect.

A nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal Pap test results for the past 10 years. The client asks about continuing the Pap test. What is the best response by the nurse?

"You may choose to discontinue this test." Explanation: The American Cancer Society recommendations for women 66+ years or older who have had normal Pap tests for 10 years and who have had a total hysterectomy may choose to stop having Pap tests for cervical cancer screening.

A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse?

"Your hair will grow back, but the new hair may be a different color or texture." Explanation: Reassure patients that hair regrowth will occur; however, advise them that the new hair may be a different color or texture.

A client with Parkinson's disease is prescribed amantadine hydrochloride 100 mg twice a day. The pharmacy supplies amantadine syrup, because the client has a history of difficulty swallowing tablets. The label reads 50 mg/5 mL. How many milliliters would the nurse administer to the client for each dose? Enter the correct number ONLY.

10 Explanation: Because each 5 mL contains 50 mg, the client would receive 10 mL for the prescribed dose of 100 mg. To calculate the amount, set up a proportion: 5/50 = x/100; cross multiply and solve for x, which is 10.

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?

Allogeneic Explanation: If the source of donor cells is from a donor other than the patient, it is termed allogeneic. Autologous donor cells come from the patient. Syngeneic donor cells are from an identical twin. Homogenic is not a type of stem cell transplant.

A 61-year-old male client is scheduled to begin chemotherapy for the treatment of his bone cancer shortly. Staff at the cancer center have educated the man and his wife about the goals, course, and expectations of his treatment. Which medications and treatments might the man anticipate needing during and after his course of treatment

Antiemetics and packed red blood cell (PRBC) transfusions Explanation: Nausea and anemia are common side effects of chemotherapy, and may be addressed with antiemetics and PRBCs. There is no noted indication with chemotherapy for corticosteroids, antiplatelet aggregators, diuretics, or SSRIs.

Which of the following is a term used to describe the process of programmed cell death?

Apoptosis Explanation: Apoptosis is the innate cellular process of programmed cell death. Mitosis is the phase of the cell cycle in which cell division occurs. Carcinogenesis is the process by which cancer arises. Angiogenesis is the process by which a new blood supply is formed.

A client whose mother and grandmother both have had cancer is at a higher risk for also developing the disease. Which tumor suppressor genes are associated with genetic susceptibility to breast cancer? Select all that apply.

BRCA1 BRCA2 Explanation: Two tumor suppressor genes called BRCA1 and BRCA2 have been identified in genetic susceptibility to breast and ovarian cancer.

A nurse interpreting a pathology report that indicates a client has an adenoma determines that the client's tumor is considered:

Benign Explanation: The nurse should interpret the adenoma as a benign tumor that originated in epithelial glandular tissue. Malignant tumors are differentiated. Apoptosis is a form of programmed cellular death.

When describing the use of the various agents for combating chemotherapy-induced nausea and vomiting, the nurse understands that the majority of these agents block:

Chemoreceptor trigger zone Explanation: The majority of agents used to control nausea and vomiting secondary to chemotherapy directly block the CTZ. They do not affect neurotransmitters, gastric acidity, or the gag reflex.

An acoustic neuroma is a benign tumor of which cranial nerve?

Eighth Explanation: An acoustic neuroma is a benign tumor of the eighth cranial nerve, the cranial nerve most responsible for hearing and balance.

The nursing student studying about cancer growth correctly identifies "cell proliferation" to mean which of the following

Increasing cell numbers by mitotic cell division Explanation: Cell proliferation is the process of increasing cell numbers by mitotic cell division. Mitosis cannot start until DNA is properly replicated. Apoptosis is a form of programmed cell death that eliminates senescent cells and some types of injured cells

During which phase of the cell cycle would a nurse expect a mitotic inhibitor to act?

M Explanation: Mitotic inhibitors act during the M phase of the cell cycle.

Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects?

Rapidly proliferating cells Explanation: Chemotherapy and radiation treatment both preferentially affect rapidly proliferating cells, which includes some normal body cells, such as epithelial and hair-follicle cells, as well as cancer cells.

As the moment of death approaches, which of the following does the nurse encourage the family to do?

Speak to the client in a calm and soothing voice. Explanation: Sight and touch diminish as the client approaches death; however, hearing tends to remain intact. Speaking to the client calmly is most appropriate.

A patient has been diagnosed with a brain tumor, a glioblastoma multiforme. The nurse met with the family after the diagnosis to help them understand that:

Surgery can improve survival time but the results are not guaranteed. Explanation: The overall prognosis for this type of aggressive brain tumor is poor but surgery can improve survival time.

Carcinomas are tumors that originate in

epithelial cells.

Some properties of neoplastic cells are the same as the properties of normal cells, including

mitosis

A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. What is the best statement by the nurse?

"I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication." Explanation: The nurse needs to explore the reason a client denies pain when pain is expected during a treatment, as with a dressing change to burns, and when the client grimaces during the dressing change. The nurse needs to educate clients about effects of pain on recovery. The nurse also cannot ignore that pain relief will hasten recovery. The nurse should not allow the client to associate pain with his dressing changes.

While doing a health history, a client tells the nurse that her mother, her grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse?

"Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." Explanation: Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The nurse cannot say that cancer can be avoided with healthy behaviors; this is inaccurate information. A family history is a reason for the client to be concerned. Cancer does not skip a generation; this response minimizes and negates the client's concern.

The client is to receive cyclophosphamide (Cytoxan) 50 mg/kg intravenously in divided doses over 5 days. The client weighs 176 pounds. How many mg of cyclophosphamide will the client receive each day? Enter the correct number ONLY.

800 Explanation: The client's weight of 176 pounds equals 80 kg. The client is to receive 50 mg of cyclophosphamide for each 1 kg of body weight. This is to be divided into 5 doses. 80 kg x 50 mg/kg = 4000 mg. 4000 mg/5 days = 800 mg.

The daughter of a client with metastatic cancer is confused as to why the client is receiving radiation therapy and asks the nurse, "Why are we still treating the cancer? The plan was only for comfort care." What is the nurse's best response?

"In this case, the radiation is being used to help alleviate the bone pain your family member is experiencing." Explanation: Radiation therapy is often used to reduce bone pain in metastatic, terminal cancers. It is not used to prolong life and does still carry negative side effects that must be weighed against the pain control benefits. The nurse should not dismiss the daughter's question about the treatment plan as family are included in treatment planning unless a client explicitly requests that a family member(s) not be provided any information

While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate?

"Tell me some more about what is on your mind." Explanation: When responding to the client, the nurse needs to acknowledge the client's fears. Having the client tell the nurse what's on his or her mind acknowledges the client's feelings and opens the way for more discussion. Asking the client about what makes him or her think he or she is dying is probing and does not address the client's feelings or needs. Telling the client that he or she will be fine gives the client false reassurance and does not address his or her fears. Asking about what the physician has told the client redirects the conversation away from the client's feelings and is inappropriate.

A 25-year-old client with cancer who is experiencing unrelieved pain rated a 9 on the pain scale requests that the hospice nurse induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia?

"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death." Explanation: When a terminally ill client or the client's legal proxy requests palliative sedation, the use of pharmacologic agents to induce sedation or near sedation when symptoms have not responded to other management measures), the purpose is not to hasten the client's death but to relieve intractable symptoms. Palliative sedation may be controversial, but it is not illegal. Total sedation is rarely indicated in hospice care to provide comfort. Continuous pain assessments are not indicated at this stage; the client requires intervention/treatment.

A nurse knows that a patient exhibiting seizure-like movements localized to one side of the body most likely has what type of tumor?

A motor cortex tumor Explanation: A tumor in the motor cortex of the frontal lobe produces hemiparesis and partial seizures on the opposite side of the body or generalized seizures. A frontal lobe tumor may also produce changes in emotional state and behavior, as well as an apathetic mental attitude. A cerebellar tumor causes dizziness; an ataxic or staggering gait with a tendency to fall toward the side of the lesion; marked muscle incoordination; and nystagmus (involuntary rhythmic eye movements), usually in the horizontal direction. An occipital lobe tumor produces visual manifestations: contralateral homonymous hemianopsia (visual loss in half of the visual field on the opposite side of the tumor) and visual hallucinations.

The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following?

A normal reaction to the diagnosis of cancer. Explanation: Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy lifestyle. They also may express anger related to the diagnosis and their inability to be in control. While depression is understandable, it also needs to be acknowledged and treated if necessary. Depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.

A 41-year-old female with a family history has had a baseline mammogram. She states that she performs monthly self breast exams but really has a hard time evaluating her lumps since she has numerous cysts. At her annual mammogram, the technician views a suspicious area and refers her to the radiologist. She asks the nurse in the office, "How can a lump appear so quickly?" The nurse's response is based on which principle?

A tumor is undetectable until it has doubled 30 times and contains at least 1 billion cells. Explanation: The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. The doubling time is the length of time it takes for the total mass of cells in a tumor to double. Tumors do no stay in the M phase of the cell cycle. Undifferentiated cancer cells do come in various shapes/sizes but this has nothing to do with the detection of the tumor by palpation. Breast cysts are fluid filled sacs but are usually not cancerous.

A client is being treated for cancer and dronabinol has been added to the client's current medication regimen. What assessment finding would indicate a therapeutic effect of this medication?

Absence of nausea Explanation: Dronabinol is an antiemetic that is a derivative of delta-9-tetrahydrocannabinol, the active ingredient in marijuana. Absence of nausea would suggest that it is having the intended effect. It is not administered to increase energy, prevent leukopenia or treat pain.

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?

Amyotrophic lateral sclerosis Explanation: Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. Parkinson disease is a slowly progressing neurologic movement disorder that eventually leads to disability. Alzheimer disease is a chronic, progressive, and degenerative brain disorder that is accompanied by profound effects on memory, cognition and ability for self-care. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.

A client and family are dealing with the client's recent terminal diagnosis. A nurse identifies a nursing diagnosis of hopelessness. Which of the following would be most helpful in supporting hope for this family? Select all that apply.

Arranging for appropriate psychosocial counseling Encouraging the client to participate in care to foster control Helping to obtain support from the community Explanation: To enable, support, and foster hope in terminally ill clients and their families, nurses should encourage and support the client's control over circumstances, choices, and environment whenever possible, make referrals for psychosocial and spiritual counseling, and assist with developing supports in the home and community when none exist. Goals set should be realistic, rather than long-term. Information and feelings should be shared. The information provided also should be accurate.

While providing care to a terminally ill client, the client's niece asks the nurse about the client's condition and prognosis. Which of the following would be most appropriate?

Ask the client's consent before sharing any information with the niece. Explanation: Before disclosing any health information about a client to family members, nurses should follow the agency's policy for obtaining consent from the client in accordance with the Health Insurance Portability and Accountability Act (HIPAA) rules. Information is shared only with the client's consent.

The nurse is caring for a client who was diagnosed with a glioma 5 months ago. Today, the client was brought to the emergency department by his caregiver because he collapsed at home. The nurse suspects late signs of rising intracranial pressure (ICP) when which blood pressure and pulse readings are noted?

BP = 175/45 mm Hg; HR = 42 bpm Explanation: With a blood pressure of 175/45 mm Hg, it is evident that this client is experiencing progressively rising ICP, resulting from an advanced stage of the brain tumor. This blood pressure demonstrates a wide pulse pressure, meaning the difference between systolic and diastolic pressure is large. A heart rate of 42 bpm indicates the client is bradycardic. This finding paired with hypertensive blood pressure with a widening pulse pressure are part of the Cushing triad related to increased ICP.

An adult client has recently begun cancer treatment with methotrexate (MTX). When reviewing this client's laboratory work, the nurse should consequently prioritize assessment of what?

BUN and creatinine Explanation: The antimetabolites may also be nephrotoxic. MTX use in clients with impaired renal function may lead to accumulation of toxic amounts or additional renal damage. Evaluation of the client's renal status should take place before and during MTX therapy. This adverse effect of MTX treatment supersedes the importance of electrolytes and ABGs, though these would also be considered.

Which term refers to the period of time during which mourning of a loss takes place?

Bereavement Explanation: Bereavement is the period of time during which mourning of a loss takes place. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Mourning is defined as the individual, family, group, and cultural expressions of grief and associated behaviors. Hospice is a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill clients and their families.

Which antineoplastic drugs are classified as antineoplastic antibiotics? (Select all that apply.)

Bleomycin (Blenoxane) Dactinomycin (Cosmegen) Daunorubicin (DaunoXome) Explanation: Antineoplastic antibiotics have similar action to alkylating drugs and include bleomycin , dactinomycin , and Daunorubicin .

A woman diagnosed with breast cancer asks the nurse how a malignant tumor in her breast could spread to other parts of her body. The nurse answers that a malignant neoplasm is made of up less well-differentiated cells that have which abilities? Select all that apply.

Break loose Enter the circulatory or lymphatic systems Form secondary malignant tumors at other sites Explanation: Malignant neoplasms are less well differentiated and have the ability to break loose, enter the circulatory or lymphatic systems, and form secondary malignant tumors at other sites. Malignant neoplasms frequently cause suffering and death if untreated or uncontrolled. Malignant neoplasms form secondary tumors at sites other than the original tumor site. Malignant neoplasms are not passed out of the body as waste through the alimentary canal.

The nurse identifies the marker for thyroid cancer as which of the following?

Calcitonin Explanation: Calcitonin is the hormonal marker for thyroid cancer. hCG is the marker for germ cell cancer of the testis, CA 125 the marker for ovarian cancer, and CEA the marker for colorectal cancers.

The nurse in the oncology unit has just admitted a client with metastatic cancer. The client asks how cancer moves from one place to another in the body. What would the nurse answer?

Cancer cells enter the body's lymph system and thereby spread to other parts of the body. Explanation: Metastasis occurs by way of the lymph channels (i.e., lymphatic spread) and the blood vessels (i.e., hematogenic spread). In many types of cancer, the first evidence of disseminated disease is the presence of tumor cells in the lymph nodes that drain the tumor area. When metastasis occurs by way of the lymphatic channels, the tumor cells lodge first in the initial lymph node that receives drainage from the tumor site. Once in this lymph node, the cells may die because of the lack of a proper environment, grow into a discernible mass, or remain dormant for unknown reasons. If they survive and grow, the cancer cells may spread from more distant lymph nodes to the thoracic duct and then gain access to the blood vasculature. Because cancer cells have the ability to shed themselves from the original tumor, they are often found floating in the body fluids around the tumor. Cancer cells are not moved from one place to another by transporter cells. Cancer cells do not form a chain to grow to the new place in the body to form a new tumor.

A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean?

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Explanation: Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.

A client is receiving idarubicin. What is the nurse's priority assessment?

Cardiac function Explanation: The client's cardiac function needs to be monitored closely because idarubicin is specifically toxic to the heart. The pancytopenia that accompanies antineoplastics can cause decreased red cell indices, but this does not address the particular threat to the cardiac system posed by idarubicin. Respiratory function is not commonly impacted by idarubicin. Electrolyte levels should be monitored in clients receiving any antineoplastic study due to adverse effects impacting nutrition and kidney function, but are not specific to idarubicin.

A client with a brain tumor is experiencing changes in cognition that require the nurse to reorient the client frequently. When performing this task, which devices would be appropriate for the nurse to use? Select all that apply.

Client's clothing Picture of the client's family Clock Calendar Explanation: Clients with changes in cognition caused by their lesions require frequent reorientation and the use of orienting devices (e.g., personal possessions, photographs, lists, and a clock). Words would not be as helpful as items that are familiar to the client.

A nurse is providing in-home hospice care to a terminally ill client. The client experiences a medical crisis requiring monitoring and medication administration. Which level of hospice care would the nurse implement?

Continuous care Explanation: Continuous care is provided in the home for management of medical crisis. Routine home care would be used to provide the usual services to a client, such as nursing care, medical social services, counseling, home health aide/homemaker services, and various therapies. Inpatient respite care would be used for a 5-day stay to provide relief for family caregivers. General inpatient care is used for symptom management that cannot be provided in the home.

Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression?

Decreased platelets and red blood cells Explanation: Most chemotherapeutic agents cause myelosuppression (depression of bone marrow function), resulting in decreased production of blood cells. Myelosuppression decreases the number of WBCs (leukopenia), red blood cells (RBCs) (anemia), and platelets (thrombocytopenia), and increases the risk of infection and bleeding. It does not typically affect electrolytes, creatinine, BUN, and CRP levels.

A client diagnosed with breast cancer will undergo a surgical procedure that includes biopsy of the sentinel node. What can be accomplished by this biopsy?

Determine the extent of the disease Explanation: The term sentinel node is used to describe the initial lymph node to which the primary tumor drains. Because the initial metastasis in breast cancer is almost always lymphatic, lymphatic spread and therefore extent of disease may be determined through lymphatic mapping and sentinel lymph node biopsy. It will not determine cause or infection, nor remove drainage.

While administering cisplatin to a client, the nurse assesses swelling at the insertion site. What is the nurse's first action?

Discontinue the intravenous medication. Explanation: If extravasation of a chemotherapeutic medication is suspected, the nurse immediately stops the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.

A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level?

Dopamine Explanation: Parkinson's disease is associated with decreased levels of dopamine resulting from degeneration of dopamine storage cells in the substantia nigra in the basal ganglia region of the brain.

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which nursing interventions should a nurse perform in such a situation?

Encourage the family members to express their feelings and listen to them in their frank communication. Explanation: Family members usually find it difficult to communicate frankly with a dying person. By encouraging family members to express their feelings and listening to them as they frankly communicate, you may help family members feel more prepared to carry on a similarly honest dialogue with the dying client. It is not advisable for the nurse to encourage conversations about the impending death of the client. Being a silent observer or encouraging the family members to spend time with the dying client may not help the family members to express their feelings.

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following?

Explore own feelings on mortality and death and dying. Explanation: To care for others in the dying process, the nurse must explore his or her own feelings about mortality and death and dying. Understanding self provides a perspective to cope with and then support clients and families experiencing pain and grief. The other options are helpful in determining appropriate nursing care but not the first step.

Which of the following is an appropriate method of assessing the dying client?

Focus on the client's basic needs. Explanation: Initially, nurses focus assessment on the client's basic physical needs, such as pain, breathing, nutrition, hydration, and elimination. The other options are inappropriate in the assessment of the dying client.

A nurse is preparing to administer imatinib to a client. The nurse expects to administer this drug by which route?

Oral Explanation: Imatinib is administered orally.

Which of the following is a physiologic response to pain?

Pallor Explanation: Physiologic responses to pain include pallor, tachycardia, diaphoresis, and hypertension.

Which phase of pain transmission occurs when the one is made aware of pain?

Perception Explanation: Perception is the pain process where one becomes aware of the pain as a result of neural activity. Modulation involves the response to noxious stimuli. Transduction refers to the processes by which noxious stimuli activate primary afferent neurons called nociceptors. Transmission describes the action potential that is created by transduction being transmitted along fibers

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions?

Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care Explanation: A key to effective listening includes allowing the client and family sufficient time to reflect and respond after asking a question. Hospice nurses with effective listening skills resist the impulse to fill the empty space in communication with talk, avoid the impulse to give advice, and avoid responses indicating, "I know just how you feel."

A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care?

The client entered a clinical trial through the National Cancer Institute. Explanation: The client involved in a clinical trial needs additional teaching about hospice care. This treatment option suggests that the client isn't ready for palliative care, which is a criterion for hospice care. Preferring not to discuss death around the girlfriend and not feeling ready to complete a will are normal responses to the grieving process. Blood transfusions are considered palliative care.

The nurse is providing care to a terminally ill client and his family who practice the Islamic faith. Which of the following concepts would the nurse need to integrate into this client's plan of care? Select all that apply.

The way a person dies is of great individual importance. Pain is viewed as a mechanism for cleansing. Death occurs through God's permission. Explanation: According to Islamic beliefs, everyone will face death and the way a person dies is of great individual importance. Death cannot happen except by God's permission. People adhering to Islamic beliefs also view pain as a cleansing instrument from God and as a compensation for sin. In Hinduism, each caste system has a different view of death, and relatives must create a new ethereal body during the first 10 days after death.

The nursing is assessing a client who has been diagnosed with a pituitary adenoma, but has not yet started treatment. The client reports having increased heart rate, hand tremors, difficulty sleeping, weight loss and hyperthermia. The nurse anticipates the client will require blood work to assess for overproduction of which hormone?

Thyroid-stimulating hormone Explanation: In clients diagnosed with pituitary tumors, increase may be seen in prolactin hormone, growth hormone, adrenocorticotropic hormone, or thyroid-stimulating hormone. In this case, the client is exhibiting symptoms related to hyperthyroidism and the blood work should include the thyroid-stimulating hormone level to determine if an overproduction of this hormone due to the presence of the tumor is the cause of the presenting symptoms.

A nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding requires immediate intervention?

Urine retention or incontinence Explanation: Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. An increase in back pain is more common because on the second postoperative day the long-acting local anesthetic, which may have been injected during surgery, will wear off. Although paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression. A mild fever is also common after surgery but is considered significant only if the temperature reaches 101° F (38.3° C).

A client is receiving radiation therapy and asks the nurse about oral hygiene. What teaching specific to the client's situation should the nurse include?

Use a soft toothbrush and allow it to air dry before storing. Explanation: The nurse advises the client undergoing radiation therapy to use a soft toothbrush to avoid gum lacerations and allow the toothbrush to air dry before storing. Gargling after each meal, flossing before going to bed, and treating cavities immediately are general oral hygiene instructions.

In caring for clients undergoing chemotherapy, the nurse should monitor for what adverse effective triggered by the cytotoxic effect of the antineoplastic medication therapy? Select all that apply.

mucositis nausea diarrhea Explanation: Common adverse effects of chemotherapy include mucositis, diarrhea, and nausea. Peripheral neuropathy and increased urine output are not typical adverse effects.

When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include?

Using a soft toothbrush to vigorously clean the mouth Explanation: Secretions are often more distressing to the family than their presence is to the client. Gentle mouth care with a moistened swab or very soft toothbrush helps maintain the integrity of the client's mucous membranes. Other helpful measures include positioning the client on the side with the head supported with pillows to allow secretions to drain freely from the mouth, gently suctioning the oral cavity, and administering prescribed anticholinergic agents sublingually or transdermally. Deeper suctioning may cause significant discomfort to the dying client and rarely is of benefit because secretions tend to reaccumulate quickly.

A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply

a) Enhances quality of life c) Integrates spirituality d) Offers a team approach to care f) Provides pain relief Explanation: The principles of palliative care include providing relief from pain and distressing symptoms. In the early course of disease, chemotherapy and radiation may be used to define care needed, but in the later stages, chemotherapy is typically not used. Psychological support including spirituality and bereavement counseling for family members is available. The care does not hasten nor postpone death but is aimed at enhancing a quality of the life that is remaining. A team approach meets the needs of the client and family.

How does a nurse who has been providing home care to a terminally ill client know that the client's condition is beginning to deteriorate?

apical pulse reaches 100 beats/minute Explanation: Failing cardiac function is one of the first signs that a client's condition is worsening. At first, heart rate increases in a futile attempt to deliver oxygen to cells. The apical pulse rate may reach 100 or more beats/minute. In clients who are dying, the skin becomes pale or mottled, nail beds and lips may appear blue, and the client may feel cold. In clients who are dying, urine volume decreases, and the jaw and facial muscles relax.

The nurse is caring for a client whose current chemotherapy regimen includes mitomycin. What is the client's most likely diagnosis?

adenocarcinoma of the pancreas Explanation: Mitomycin is used before the treatment of disseminated adenocarcinoma of the stomach and pancreas. It is not indicated in the treatment of non-Hodgkin lymphoma, lung cancer, or neuroblastoma.

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin. The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should:

administer a combination of antiemetics prior to the administration of the drug. Explanation: Antiemetics should be administered proactively rather than waiting until the client's nausea becomes unbearable. A combination approach is often effective. A low-residue diet is unnecessary, and withholding food does not necessarily reduce nausea

A client has been diagnosed with cancer and will begin aggressive treatment. The client's course of treatment includes drug therapies that affect cyclins and cyclin-dependent kinases (CDKs). This drug will achieve a therapeutic effect by:

affecting the progression of cells through the process of cell division. Explanation: The cyclins are a family of proteins that control the entry and progression of cells through the cell cycle. Manipulation of cyclins, CDKs, and CDK inhibitors serves as the basis for development of newer forms of drug therapy that can be used in cancer treatment. These types of drugs would not cause cell atrophy and they do not have a direct effect on the role of stem cells.

Which agents would be considered cancer non-cell cycle specific agents?

alkylating agents Explanation: Alkylating agents affect cells in all phases of the cell cycle and are considered non-cell cycle specific. Antimetabolites are considered to be S phase specific agents. Mitotic inhibitors are cell cycle-specific agents working in the M phase of the cell cycle. Protein tyrosine kinase inhibitors target specific enzymes needed for protein building by specific tumor cells. They do not affect healthy human cells.

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis?

allopurinol Explanation: The nurse may be asked to administer allopurinol to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Leucovorin provides folic acid to cells after methotrexate administration.

A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.)

assesses the client for any sun exposure avoids shaving the irradiated skin Explanation: The client receiving external beam radiation therapy may experience trauma to the irradiated skin. To prevent further skin damage, the client is to avoid sun exposure and shaving the irradiated skin area. Other skin areas are not damaged, only the irradiated skin. Lukewarm water is to be used to bathe the area. Water of extreme temperature should be avoided. Many over-the-counter ointments contain metals and may cause additional skin damage.

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

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

A client is being treated for stomach cancer. The client is in considerable and constant pain, and the family is asking why. How does soft tissue cancer cause pain?

by compressing and eroding blood vessels, causing ulceration and necrosis Explanation: The interruption of tissue integrity is responsible for the majority of pain in cancer. The physical compression is the cause of pain in bone cancer but not usually in soft tissue. There is no rearrangement of neurons that results in pain; rather, it results in loss of sensation. If the pain were to be caused by the flow of food into the stomach, it would only appear following a meal.

What does it mean that some cell populations have self-renewing multipotent stems cells? Some cells:

can differentiate into different epithelial cell types throughout life. Explanation: Some cell populations have self-renewing multipotent stem cells, such as the epithelial stem cells, that can differentiate into the different cell types throughout life.

. Cancer drugs are given in combination and over a period of time because it is difficult to affect

cells in the dormant phase of the cell cycle.

. Cancer can be a difficult disease to treat because

cells remain dormant, emerging months to years later.

A client is receiving tamoxifen. Which adverse effect would be most specific to the action of this drug?

menopausal effects Explanation: Tamoxifen belongs to the group of drugs that are hormones or hormone modulators. These agents are hormone specific. This drug competes with estrogen at the receptor sites, ultimately blocking estrogen. The adverse effects specific to this action would involve menopause-associated effects. Bone marrow suppression, GI toxicity, and hepatic dysfunction occur with this drug, but these are not specific to the drug's action.

A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care?

daily weights Explanation: Imatinib may be associated with edema and significant fluid overload. Patients should be weighed regularly and assessed for signs of fluid retention. Reflexes, bilateral inequalities in blood pressure, and alterations in pupil response are not associated with the use of imatinib.

Based on the nurse's understanding of antineoplastic drugs, the nurse would anticipate administering which in conjunction with doxorubicin as a cardioprotective agent?

dexrazoxane Explanation: Dexrazoxane is administered concomitantly with doxorubicin as a cardioprotective agent. Leucovorin provides folic acid to cells after methotrexate administration. Mesna binds with metabolites of ifosfamide to protect the bladder from hemorrhagic cystitis. Amifostine binds with metabolites of cisplatin to protect the kidneys from nephrotoxic effects, reduces xerostomia.

A nurse is caring for a child with a history of cancer who was treated with moderate doses of radiation therapy. Which pediatric symptom is commonly experienced in this population?

undergoing a period of DNA synthesis and replication of the chromosomes. Explanation: The S phase, which takes about 10 to 12 hours, is the period of DNA synthesis and replication of the chromosomes. The M phase, which usually takes less than an hour, involves formation of the mitotic spindle and cell division with formation of two daughter cells. G1 is the stage during which the cell is starting to prepare for DNA replication and mitosis through protein synthesis and an increase in organelle and cytoskeletal elements. G2 is the pre-mitotic phase. During this phase, enzymes and other proteins needed for cell division are synthesized and moved to their proper sites.

A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life?

weight loss and inadequate food intake Explanation: The nurse should report weight loss and inadequate food intake so that the team can consider adding appetite stimulants and the nutritionist can alter the meal plan to give more satisfying meals as a comfort measure. The nurse knows that changes of gastrointestinal function such as irregular eating or bowel changes occur as part of the dying process and are not relevant to the desired intervention. Deteriorating vital signs are part of the dying process so that these signs are not relevant to the desired intervention.

A nurse reads that a client's cancer growth fraction is 2:1. Which interpretation by the nurse is most accurate?

There are twice as many dividing cells as resting. Explanation: The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction.

Start of Ch 14 Karch . A patient is receiving carboplatin. The nurse would expect to administer this drug by which route?

Intravenous Explanation: Carboplatin is administered IV on day 1 every 4 weeks.

It is important to explain to women that chemotherapeutic agents should not be used during pregnancy because

of potential serious adverse effects on the rapidly multiplying cells of the fetus.

The nurse should teach the patient who is being radiated about protecting his skin and oral mucosa. An important teaching point would be to tell the patient to:

Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. Explanation: The patient should cleanse himself with a mild soap using his fingertips rather than a wash cloth. All the other choices will irritate the skin and fail to protect it from additional injury.

Which of the following outcomes would be most appropriate to include in the plan of care for a client diagnosed with a muscular dystrophy?

Client participates in activities of daily living using adaptive devices. Explanation: The muscular dystrophies are a group of incurable muscle disorders characterized by progressive weakening and wasting of the skeletal or voluntary muscles. Nursing care focuses on maintaining the client at his or her optimal level of functioning and enhancing the quality of life. Therefore, the outcome of participating in activities of daily living with adaptive devices would be most appropriate. Medications are not used to treat these disorders; however, they may be necessary if the client develops a complication such as respiratory dysfunction. The disorder is incurable and progressive, not chronic. Diagnostic follow-up would provide little if any information about the course of the disorder.

A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend?

Oranges Explanation: A diet high in vitamin C and citrus may help reduce the risk of certain cancers, such as stomach and esophageal cancers. Hot dogs and smoked and cured foods are high in nitrates, which may be linked to esophageal and gastric cancers. Steak is a high-fat food that may increase the risk of breast, colon, and prostate cancers.

A patient is diagnosed with an aggressive, primary malignant brain tumor. The nurse is aware that the glioma:

Originated within the brain tissue. Explanation: The most aggressive type of malignant brain tumor is a glioma, which originates within the brain tissue.

The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient?

Coumadin Explanation: Although deep vein thrombosis and pulmonary embolism occur in about 15% of patients and cause significant morbidity, anticoagulants are not prescribed due to the risk for CNS hemorrhage.

A patient who is receiving methotrexate is also receiving leucovorin. The nurse understands that this drug is being given for which reason?

Counteract effects of methotrexate Explanation: Leucovorin is administered with methotrexate to counteract the effects of methotrexate treatment.

Which procedure uses liquid nitrogen to freeze tissue, thereby destroying cells?

Cryoablation Explanation: Cryoablation uses liquid nitrogen or a very cold probe to freeze tissue, causing cell destruction. Electrosurgery, chemosurgery, and laser surgery do not use liquid nitrogen to freeze tissue.

The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome?

An aunt and uncle diagnosed with cancer Explanation: The hallmarks of hereditary cancer syndrome include cancer in two or more first-degree or second-degree relatives, early onset of cancer in family members younger than age 50, the same type of cancer in several family members, individual family members with more than one type of cancer, and a rare cancer in one or more family members.

In referring to growth and development with children, when does the nurse recognize this process begins?

From the time the ovum is fertilized Explanation: The gametes (ovum and sperm) are haploid, having only one set of chromosomes from one parent, and are designed specifically for sexual fusion. After fusion, a diploid cell is formed. In terms of proliferation, the cells divide immediately. Growth and development is an ongoing dynamic process that begins with a fertilized ovum and continues through the infant, childhood, and adolescent periods until adulthood is achieved.

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

Allows for the nurse to facilitate the grieving process Explanation: Grieving is a painful yet normal reaction that helps clients cope with loss and leads to emotional healing. The nurse is responsible for facilitating the grieving process and helping the client and family deal with their emotions.

A nurse is caring for a terminally ill client who is receiving chemotherapy and radiation for an aggressive lung cancer. The treatment success is limited in shrinking the tumor, and the treatments are making the client very ill. The client states, "I feel that I would like to stop treatments. I would like to enjoy the time that I have remaining with my family." Which emotional reaction does the nurse recognize that the client is experiencing?

Acceptance Explanation: In the final stage, dying clients accept their fate and makes peace spiritually and with those to whom they are close. Clients begin to detach themselves socially and wish to be with only a small group of close friends and family. The other options are stages that occur earlier in the process.

Which is a sign or symptom of septic shock?

Altered mental status Explanation: Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.

Which medication classification should be avoided in the treatment of brain tumors?

Anticoagulants Explanation: Anticoagulants usually are not prescribed because of the risk for central nervous system (CNS) hemorrhage; however, prophylactic therapy with low-molecular-weight heparin is under investigation. Osmotic diuretics, corticosteroids, and anticonvulsants are utilized in the treatment of brain tumors.

Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death?

Dusky appearance Explanation: The body becomes dusky or bluish, waxen-appearing, and cool; blood darkens and pools in dependent areas of the body, and urine and stool may be evacuated.

The nurse identifies a nursing diagnosis of self-care deficit, bathing related to motor impairment and decreased cognitive function for a client with cerebral metastasis. Which outcome would the nurse most likely identify on this client's plan of care?

Client participates in daily hygiene activities with assistive devices. Explanation: The client has a self-care deficit related to bathing. Therefore, an appropriate outcome would address the client's participation in daily hygiene measures. Positive coping strategies would be appropriate for a nursing diagnosis associated with anxiety or fear. Verbalizing feelings about self-care ability would be more appropriate for a nursing diagnosis involving self-esteem or role function. Consuming adequate calories would be appropriate for a nursing diagnosis involving imbalanced nutrition, less than body requirements.

A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance?

Erythropoietin Explanation: Clients may receive parenteral cytotoxic drugs as outpatients and return home, or these and other antineoplastic drugs may be administered at home by the client or a caregiver. If a client is receiving erythropoietin or oprelvekin subcutaneously, the client or a caregiver may need to be taught injection technique

After teaching a group of students about antineoplastic antibiotics, the instructor determines that the teaching was successful when the students identify which drug as an example?

Doxorubicin Explanation: Doxorubicin is the prototype antineoplastic antibiotic. Vincristine is the prototype mitotic inhibitor. Imatinib is the prototype protein tyrosine kinase inhibitor. Methotrexate is the prototype antimetabolite.

The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease?

Drugs administered may cause a wide variety of adverse effects. Explanation: Drugs administered for Parkinsonism may cause a wide variety of adverse effects, which requires careful observation of the client. Over time, clients may respond less and less to their standard drug therapy and have more frequent "off episodes" of hypomobility. As a result, the nurse should administer the drugs closely to the schedule. Generally, a single drug called levodopa is administered to clients with Parkinson's disease. It is also not true that drugs may not cause the requisite therapeutic effect or such clients do not adhere to the drug regimen.

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 Explanation: 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.

Which is also known as a proxy directive?

Durable power of attorney for health care Explanation: A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. The other options are incorrect.

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding?

Dysphonia Explanation: Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?

Extravasation Explanation: The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.

A nursing student says the following to her instructor: "Malignant neoplasms are more well-differentiated than benign tumors." Which of the following is the answer?

False Explanation: Malignant neoplasms are less well-differentiated tumors that have lost the ability to control both cell proliferation and differentiation.

What is the most common type of brain neoplasm?

Glioma Explanation: Gliomas are the most common brain neoplasms, accounting for about 45% of all brain tumors. Angiomas account for approximately 4% of brain tumors. Meningiomas account for 15% to 20% of all brain tumors. Neuromas account for 7% of all brain tumors.

A client tells the nurse that he is receiving cancer treatment that involves strengthening the immune system. The nurse documents that the client is receiving which treatment?

Immunotherapy Explanation: The nurse documents that the client is receiving immunotherapy, defined as a cancer treatment modality designed to heighten the person's general immune responses in order to increase tumor destruction.

Which is a growth-based classification of tumors?

Malignancy Explanation: Tumors classified on the basis of growth are described as benign or malignant. Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias.

A nursing instructor sees the need for further instruction when one student makes which statement concerning cancer?

Malignant neoplasms tend to grow slowly. Explanation: Malignant neoplasms, which invade and destroy nearby tissue and spread to other parts of the body, tend to grow rapidly and spread widely and have the potential to cause death

A nurse is providing care to a terminally ill client who follows Islamic traditions and is experiencing pain. When developing a plan of care for this client, an understanding of which of the following would the nurse need to integrate into the plan?

Pain is viewed as a means of cleansing by God. Explanation: The Islamic religion views pain as a cleansing instrument of God. Pain relief is appropriate when there is no doubt that the person's disease is causing untreatable suffering. However, all parties involved must agree formally to the method(s) chosen. Good karma, a view of Hinduism, leads to rebirth. Repentance is a view associated with traditional Christianity.

A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk?

Pain radiating down the posterior thigh Explanation: A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg. Slight knee flexion should relieve, not precipitate, lower back pain. If nerve root compression remains untreated, weakness or paralysis of the innervated muscle group may result; lower leg atrophy may occur if muscles aren't used. Homans' sign is more typical of phlebothrombosis.

Which of the following is a late symptom of spinal cord compression?

Paralysis Explanation: Later symptoms include evidence of motor weakness and sensory deficits progressing to paralysis. Early symptoms associated with spinal cord compression include bladder and bowel dysfunction (urinary incontinence or retention; fecal incontinence or constipation).

The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain?

Parkinson disease Explanation: In some patients, Parkinson disease can be controlled; however, it cannot be cured. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits?

Rapid, jerky, involuntary movements Explanation: The most prominent clinical features of the disease are chorea (rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes (Aubeeluck & Wilson, 2008).

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement?

Related to impaired balance Explanation: A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.

A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client?

Respect the client's and family members' choices. Explanation: In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. Sharing emotional pain is a role in providing care and comfort to dying clients and their families. When the client has a living will, physicians must abide by the client's wishes. The nurse should ask the family members about spiritual care only if the client wants someone associated with his or her religion.

The nurse's major area of assessment for a patient receiving patient-controlled analgesia is assessment of what system?

Respiratory Explanation: Essential to the safe use of a basal rate with PCA is close monitoring by nurses of sedation and respiratory status and prompt decreases in opioid dose (e.g., discontinue basal rate) if increased sedation is detected

A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring?

Riluzole Explanation: Riluzole, a glutamate antagonist, has been shown to prolong survival for persons with ALS for 3 to 6 months.

A terminally ill client is receiving morphine around-the-clock for pain control. As part of the client's plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify?

Risk for constipation related to the effects of an opioid Explanation: When an opioid is used for around-the-clock pain management, the nursing diagnosis, risk for constipation, would be most likely because of the opioid's effect on the gastrointestinal system. Therefore, a regimen to combat constipation is key. Although opioids depress the central nervous system and cause sedation, a risk for infection and impaired physical mobility would be less likely. Other factors involved in the client's care, not just the around-the-clock pain control, would contribute to caregiver role strain.

Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy?

Risk for impaired gas exchange Explanation: Problems that may develop with opioid and opiate therapy include risk for impaired gas exchange related to respiratory depression, constipation related to slowed peristalsis, and risk for injury related to drowsiness and unsteady gait.

A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?

Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected. Explanation: By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be more effective than current treatments and less harmful to normal cells so that they may produce fewer adverse effects. However, adverse effects are not wholly absent. These drugs are not normally used as cancer prophylaxis and many are prohibitively expensive.

A client is administered mesna to prevent cystitis induced by ifosfamide. How will this medication combination prevent cystitis?

The medication combines with the metabolite of ifosfamide. Explanation: Mesna is used with ifosfamide, which produces a metabolite that causes hemorrhagic cystitis. Mesna combines with and inactivates the metabolite, thereby decreasing cystitis.

A nurse is developing a teaching plan for a terminally ill client and his family about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan?

The stages are applicable to any loss. Explanation: The five stages of dying describe the five emotional reactions applicable to the experience of any loss. Not every client or family member experiences every stage. Many clients never reach a stage of acceptance. Clients and family fluctuate on a sometimes daily basis in their emotional responses.

An oncology nurse who has worked for many years providing care for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job?

There will be a greater number of cancers that are epithelial in origin. Explanation: Epithelial cancers are more common in adults, while "blastomas" and cancers of the hematopoietic system such as leukemia are more common in children

Despite having been administered prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea?

Use imagery, humor, and progressive relaxation Explanation: Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication and to reduce dyspnea. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help in potentiate the effects of pain medication.

In spite of administering the prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea?

Use imagery, humor, and progressive relaxation Explanation: Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help potentiate the effects of pain medication.

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?

antimetabolite Explanation: 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR).

A client's tissue biopsy reveals the presence of cells that appear to have abnormalities in shape and size. Carcinoma is suspected because these cells possess the characteristics of:

loss of differentiation. Explanation: The deviation from normal patterns of differentiation is a characteristic of cancer cells. Angiogenesis is also associated with malignancy, but this does not directly account for abnormalities in size and shape. Cohesiveness, adhesion, and cell density-dependent inhibition are characteristics of normal cells.

When preparing to administer ondansetron for a patient's nausea and vomiting, the nurse understands that this agent blocks:

serotonin. Explanation: Ondansetron blocks serotonin receptors in the chemoreceptor trigger zone.

The nurse is caring for a client who has diminished lung function due to emphysema. The terminally ill client is short of breath on exertion and reports difficulty sleeping in bed. The client states, "I am so afraid of getting any worse." Which statement, by the nurse, assists the client in sustaining hope?

"I will talk with the health care provider to determine the next step in your care." Explanation: The client is assisted in hopefulness by believing that the healthcare team will make his remaining days meaningful. By conveying a sense that the nurse will discuss the client's condition with the health care provider, the client recognizes that the healthcare team will use whatever treatment and comfort measures are available. Telling a client not to worry is not therapeutic and is condescending. Waiting for a grandchild does not address the client's thought. Reflecting what the client said for clarification opens communication but does not instill hopefulness.

A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse?

"It will allow time for the repair of healthy tissue." Explanation: In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death.

A client informs the nurse that he has been taking ibuprofen every 6 hours for 3 weeks to help alleviate the pain of arthritis. The client has a history of a gastric ulcer and is taking a proton pump inhibitor for the treatment of this disorder. What should the nurse instruct the client about the use of the ibuprofen?

"It would be best to contact the physician prior to take any over-the-counter medications." Explanation: Clients should not use an over-the-counter analgesic agent, such as aspirin, ibuprofen, or acetaminophen, consistently to treat chronic pain without first consulting a physician. Ibuprofen is not contraindicated when taking a proton pump inhibitor. Option D is accusatory and not a therapeutic response

While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply.

"This must be very difficult for you." "Tell me more about what's on your mind." Explanation: The nurse needs to listen effectively and empathetically, acknowledging the client's fears and concerns. Statements such as "This must be very difficult for you" and "Tell me more about what's on your mind" address the client's concerns and help to focus the discussion on the client. Telling the client that the nurse knows how the client feels ignores the client's concerns. Saying that there is still time for a good life or telling the client to focus on what the doctor has planned ignores the client's feelings and blocks communication.

The client is taking continuous-release oxycodone for chronic pain and now reports constipation. What should be the first question the nurse asks the client?

"When was your last bowel movement?" Explanation: Constipation is a common side effect of opioids. The nurse needs to assess the situation first before intervening. Asking about date of last bowel movement is most important. Once the history of constipation is completed, it would then be appropriate for the nurse to ask about effectiveness of past interventions and begin teaching about interventions, such as increasing fluids and fiber.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

Administering metoclopramide and dexamethasone as ordered Explanation: The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.

The client takes naproxen for arthritic pain and is now prescribed warfarin for persistent atrial fibrillation. Due to the interactions of the medications, what is the nurse's best response?

Assess the client's stool for color Explanation: Clients who take NSAIDs, such as naproxen (Aleve), with warfarin (Coumadin) may experience gastrointestinal bleeding. The nurse will need to monitor for this. Clients are to ingest a consistent level of vitamin K. Administering the medications with food does not increase absorption. Ingesting food with the medications may decrease gastrointestinal upset. Clients are instructed to not ingest alcohol.

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action?

Ensure that all staff and visitors adhere to infection control precautions. Explanation: The client's combination of cancer and bone marrow suppression creates an acute risk for infection. As a result, infection control is vital to maintaining the client's health and safety. Nutrition and energy conservation strategies are also important, but infection control is a safety priority. The client likely has a risk for bleeding, but the harm of activity limitation outweighs the benefits for most clients

A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival.

Palliative care Explanation: In a study of referral to palliative care for clients newly diagnosed with a disease with very poor prognosis, researchers found that those clients receiving palliative care plus standard oncology demonstrated improved quality of life and mood and had longer median survival. Radiation is primarily used when a cancer spreads to other organs, and it has not been proven to affect mood. Angiogenesis is the growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth. Respite care is provided on an occasional basis to relieve the family caregivers.

A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis?

Provide a solution of viscous lidocaine for use as a mouth rinse. Explanation: To decrease the pain of stomatitis, the nurse should provide a solution of viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection, but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.

A client who is taking chemotherapeutic medications has developed stomatitis. What intervention should the nurse include in the client's plan of care?

Provide mouth care frequently. Explanation: Stomatitis requires frequent mouth care. Commercial mouthwashes are likely to burn any open lesions, and stomatitis does not have a fungal etiology. Spicy or exceptionally hard foods should be avoided, but there is no need to limit the client's diet to minced and pureed foods.

A client is prescribed doxorubicin drug therapy for carcinoma of the breast. On the second day of drug therapy, she calls in to report reddish urine. What should the nurse do?

Reassure the client that it is a harmless and expected response to the drug. Explanation: Reddish urine is observed within a day or two after doxorubicin injection. The client should be reassured that it is a harmless and expected response to the drug. Nonpharmacologic interventions should be reviewed only if the client reports nausea and vomiting. Though it is necessary to reassure the client about adequate monitoring and follow-up in her home setting and caution her against taking aspirin, these suggestions do not pertain to the occurrence of reddish urine.

Which is a gastrointestinal route for administration of analgesics?

Rectal Explanation: A gastrointestinal route of administration of analgesics is the rectal route. The epidural space, oral mucosa, and subcutaneous sites are not related to the gastrointestinal route.

The nurse is assessing a client with a confirmed spinal cord tumor. The client states, "I've been too embarrassed to tell anyone but, I have been awakened at night because I've wet the bed." It would be a priority for the nurse to further assess the client for which complication?

Spinal cord compression Explanation: With spinal tumors, there is the risk of compression from the tumor on structures and organs surrounding the spinal cord. Urinary incontinence indicates decreased spinal cord function due to spinal cord injury related to compression from the tumor. Although the nurse may include further assessment for urinary tract infection, knowledge deficit and impaired skin integrity, these would not be the priority assessment. Spinal chord compression is considered a medical emergency and requires immediate treatment to prevent permanent neurologic damage.

A patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient complains of severe pain in the back. What is pain an indicator of in a patient with a spinal cord tumor?

Spinal metastasis Explanation: Pain is the hallmark of spinal metastasis. Patients with sensory root involvement may suffer excruciating pain, which requires effective pain management.

A preschool-age child is admitted for complaints of abdominal pain and vomiting. What is the best method for the nurse to collect data about the pain level of the child?

The Wong-Baker FACES scale Explanation: The Wong-Baker FACES scale is best for pediatric, culturally diverse, and mentally challenged clients. It uses pictures and short descriptive phrases. The preschool-age child would have difficulty understanding the meaning of numbers in relation to pain. Asking the child to describe the pain does not give information about the level of pain the child is experiencing. Because the preschool child has a limited vocabulary, a word scale would not be appropriate for the rating of pain.

The nurse educator is providing orientation to a new group of staff nurses on an oncology unit. Part of the orientation is to help nurses understand the differences between various types of brain tumors. The nurse educator correctly identifies that glioma tumors are classified based on the fact that they originate where in the brain?

Within the brain tissue Explanation: Gliomas tumors are a type of intracerebral brain neoplasm. They originate within brain tissue. Tumors arising from the coverings of the brain include meningiomas. These tumors grow on the membrane covering of the brain, called the meninges. An acoustic neuroma is an example of tumors that grow out of or on cranial nerves and cause compression leading to sensory deficits. Metastasis refers to spreading of any kind of malignant primary tumor. This term is not specific to any one classification of tumor.

Antineoplastic drugs destroy human cells. They are most likely to cause cell death among healthy cells that

are rapidly turning over.

A client reports having joint pain that has gotten worse over the last year despite gradually increasing doses of an OTC pain reliever. Which type of pain will the nurse document as the chief complaint?

chronic pain Explanation: This client is experiencing chronic pain, which is pain or discomfort that lasts for a period longer than 6 months. Pain or discomfort with a short duration is acute pain. It is associated with trauma, injury, or surgery. Referred pain is pain felt in the body in a location that is different from the actual source of the pain. Breakthrough pain is a period of acute pain experienced by those suffering from chronic pain

The nurse is assessing a client for adverse effects related to methotrexate therapy. What diagnostic finding should the nurse prioritize?

creatinine clearance Explanation: Methotrexate is nephrotoxic. Consequently, the nurse must carefully follow indicators of the client's renal function. Electrolyte and water disturbances and cardiac conduction disorders are much less likely adverse effects

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply.

dietary substances environmental factors viruses Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.

The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply.

dietary substances environmental factors viruses chemical agents defective genes hormone replacement therapy Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy.

The nurse is providing medication education to a client with breast cancer who has been prescribed tamoxifen. How should the nurse explain the action of the drug?

slows the growth of cancer cells Explanation: Antineoplastic hormone inhibitors slow the growth of cancer cells. They do not treat cancer by causing apoptosis (cell repair) or mutations. They do not influence healthy body cells in the area of the tumor.

A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis?

Risk for infection related to inadequate defenses Explanation: Physiological needs, such as risk for infection, take priority over the client's other needs.

A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?

Severe lower back pain Explanation: The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet - usually unilaterally. A herniated disk also may cause sensory and motor loss (such as foot drop) in the area innervated by the compressed spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?

Shorten the period of neutropenia Explanation: Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.

The nurse in the oncology outpatient clinic receives a phone call from a family member of a client who was diagnosed with a metastatic spinal cord tumor. The family member informs the nurse that the client has been reporting increased back pain in the region of the tumor and dizziness. How should the nurse respond?

Tell the family member to get the client to hospital for emergency assessment Explanation: The client's reported symptoms are indicative of spinal cord compression, a complication of spinal cord tumors that can lead to permanent paralysis and several other irreversible sensory impairments. Signs and symptoms of spinal cord compression warrant an urgent assessment, because it is an emergency. Providing education regarding pain management, sharing information about expected symptoms and encouraging the client to lie in the prone position are all ineffective and unsafe nursing actions, because the presenting complaints warrant emergency assessment and intervention.

A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following?

Dyskinesia Explanation: Most clients within 5 to 10 years of taking levodopa develop a response to the medication called dyskinesia, manifested as facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk and extremities. Bradykinesia refers to an overall slowing of active movement and is a manifestation of the disorder. Micrographia refers to the development of small handwriting as dexterity declines with Parkinson's disease. Dysphonia refers to soft, slurred, low-pitched, and less audible speech that occurs as the disorder progresses.

When discussing the cell cycle in an oncology lecture, the faculty mentions that highly specialized cells like neurons may permanently stay in which cell cycle?

G0 phase Explanation: When environmental conditions are adverse, such as nutrient or growth factor unavailability, or cells become terminally differentiated (i.e., highly specialized), cells may exit the cell cycle, becoming mitotically quiescent and reside in a special resting state known as G0. Cells in G0 may reenter the cell cycle in response to extracellular nutrients, growth factors, hormones, and other signals such as blood loss or tissue injury that trigger cell renewal. Highly specialized and terminally differentiated cells, such as neurons, may permanently stay in G0.

Which of the following nursing interventions will a nurse perform to transfer heat and improve circulation in a dying client?

Gently massage the arms and legs. Explanation: A nurse should gently massage the client's arms and legs to transfer heat and improve circulation in a dying client. Changing the position frequently helps protect the client's skin from breakdown. Administering warm intravenous fluids and intramuscular injections will not help transfer heat and improve circulation in a dying client.

The nurse is providing discharge teaching for a client who was admitted to hospital after having complex partial seizures secondary to a glioma. The client has been prescribed levetiracetam to manage the seizures. What should the nurse include in the discharge teaching for this medication?

"Driving a car should be avoided until the you know how this medication effects you." Explanation: The nurse should caution the client against driving until the client has a good understanding of how the medication affects his or her central nervous system. For some individuals, the degree of somnolence is much greater than for others and, in some cases, the somnolence is higher when the medication is first initiated and then begins to lesson with physiological adaptation. If a dose is forgotten, the client should be told to take the same dose as soon as he or she remembers. If the time is too close to the following day's dose, the client should be instructed to omit the previous day's dose and just take the current day's dose only. The client should never double up on the dose. There are no cautionary concerns about taking the medication at the same time as a glucocorticoid. There are no established drug-drug interactions between these two type of medications. Suicidal ideation is a rare side effect of levetiracetam. Although the nurse can provide education to the client about this rare side effect, the nurse must indicate this is not a common finding with this medication.

The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse?

"I can continue taking my vitamins and herbs because they make me feel better." Explanation: Herbal products are not regulated by the U.S. Food and Drug Administration (FDA);although some can decrease the risk of cancer, others can have serious side effects and liver toxicity. Use of vitamins and herbals should be reviewed with the oncologist. Use of clear liquids is recommended for the client experiencing nausea and vomiting. Because hair follicles are sensitive to chemotherapy drugs, it is likely for alopecia to occur especially with consecutive treatments. Chemotherapy includes cytotoxic drugs that are harmful to rapid dividing cells such as cell development in the fetus. To prevent damage to the fetus, birth control is recommended during treatment.

The nurse is providing end-of-life care to a client who was diagnosed with glioblastoma multiforme (GBM) 8 months ago. Despite a calm interaction with the client 1 hour ago, the client is now angry and yells, "Get out of my room and don't touch me anymore. I don't need your help!" How should the nurse respond?

"I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back." Explanation: Personality changes, mood swings and irritability can be common manifestations of both growth of the brain tumor and also the process of grief and loss, such as in the case of the client who is receiving end-of-life care. The client's anger and yelling at the nurse is indicative of ineffective coping and warrants the nurse to take a therapeutic approach when responding to the anger. Acknowledging that the client is not ready to receive care at the moment and asking the client to contact the nurse when he or she is ready enables to client to maintain control and promotes self-esteem. Telling the client to speak to the nurse's supervisor does not promote a strong nurse-patient relationship and is not a supportive way to manage end-of-life care. Telling the client that he or she is not permitted to speak to the nurse "that way" may increase the client's anger and puts limits on the client's sense of control. This response does not promote an effective nurse-patient relationship. The nurse must use extra caution when responding to a client who is experiencing emotional swings when faced with death and dying. By stating, "I can see you no longer want me as your nurse," the nurse is making an assumption that the client does not want him or her as the nurse any longer. By making this statement, the nurse is limiting opportunities for the client to verbalize feelings and emotions related to stress, grief and loss.

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?

"I floss my teeth every morning." Explanation: A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.

A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed?

"I guess the doctor could not remove the entire tumor." Explanation: Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.

A client with a diagnosis of non-small-cell lung cancer is currently undergoing chemotherapy. At the encouragement of a family member, the client has announced to the nurse the intention to complement this treatment with a regimen of herbal remedies. How should the nurse respond to this client's statement?

"It's important to discuss what herbs you'll be taking with your health care provider or the pharmacist to make sure there aren't any interactions." Explanation: Herbal remedies are not necessarily contraindicated during chemotherapy, but their safety must be carefully assessed to prevent adverse interactions.

A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client?

"Let's take this one day at a time; remember you have your daughter's dance recital next week." Explanation: Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Although he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Reponses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.

The nurse and a nursing student are admitting a client with a malignant glioma brain tumor preoperatively for resection of the tumor. The nursing student asks the nurse, " I was told these types of tumors have a very poor prognosis. Why is the tumor being resected?" Which rationale for this intervention is true?

"Surgical resection of the tumor will decrease intracranial pressure." Explanation: For clients with malignant glioma, complete removal of the tumor and cure are not possible, but the rationale for resection includes relief of intracranial pressure, removal of any necrotic tissue, and reduction in the bulk of the tumor, which theoretically leaves behind fewer cells to become resistant to radiation or chemotherapy. Due to the poor prognosis with this tumor, it is not likely that the surgical resection is considered a life-saving measure. Rather the surgical intervention is a means to manage symptoms in the palliative phase of the client's disease. Surgical resection does not eliminate the need for chemotherapy. Due to the malignant nature of this tumor, the surgery will not completely eliminate the tumor, but chemotherapy can be administered to eradicate or slow further cell growth to promote comfort in the palliative phase of the disease. In the case of this client, reversal of paralysis caused by brain tumor compression 6 months ago is not possible. This would not be the aim of the surgical resection.

Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care?

"Tell me who or what gives you strength." Explanation: Spirituality is a personal belief system that focuses on a search for meaning and purpose of life. Assessment of people or things that provide strength to a terminally ill client is one way the nurse provides spiritually sensitive patient care. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors.

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes. Is he in pain?" Which response by the nurse would be most appropriate?

"The moaning you hear is from air moving over very relaxed vocal cords." Explanation: As a client approaches death, certain signs appear. The family is reporting irregular breathing with periods of apnea. The moaning that they hear reflects the sound of air passing over very relaxed vocal cords. It does not signify pain or distress. Therefore, no additional pain medication would be needed. Secretions collecting at the back of the throat are noted by a rattling or gurgling sound. Decreased oxygen to the brain would lead to confusion, which may be reported by the client as strange dreams or visions.

A client is diagnosed with a brain tumor. The client is told that the cancer cells proliferate. The client asks the nurse what this means. What is the nurse's best response?

"The proliferation is the growth of cancer cells and the rate of growth." Explanation: The proliferation of cancer cells is the rate of growth of cancer cells. The proliferation of cancer cells is not the metastasis of the tumor, suppression of the cancer cells, or treatment with chemotherapy.

A client received an injection of doxorubicin and is now observing a reddish urine. The client reports blood in the urine to the nurse. How should the nurse respond?

"The reddish urine is an expected response to the drug." Explanation: Reassure clients that reddish urine after doxorubicin injection is a harmless and expected response to the drug. This reaction may happen within 1 to 2 days postinfusion.

A client with a malignant glioma is scheduled for surgery. The client demonstrates a need for additional teaching about the surgery when he states which of the following?

"The surgeon will be able to remove all of the tumor." Explanation: For clients with malignant gliomas, complete removal of the tumor and cure are not possible but the rationale for resection includes relief of increased intracranial pressure, removal of any necrotic tissue, and reduction in the bulk of the tumor, which theoretically leaves behind fewer cells to become resistant to radiation or chemotherapy.

While studying for a pathophysiology exam on cells and tissue repair, a student asks, "What happens if, in the process of going through the cell cycle, a cell is damaged?" Which is the best response?

"There are built-in checkpoints in the cell cycle to allow for defects to be edited and repaired." Explanation: Within the cell cycle are checkpoints where pauses or arrests can be made if the specific events in the phases of the cell cycle have not been completed. There are also opportunities for ensuring the accuracy of DNA replication. These DNA damage checkpoints allow for any defects to be edited and repaired, thereby ensuring that each daughter cell receives a full complement of genetic information, identical to that of the parent cell.

A woman is surprised to read on the Internet that certain infections can cause cancer, and has sought clarification from her family physician during an office visit. How can the physician best respond to the woman's query?

"There are many viruses, but only a very few of them have been shown to cause cancer in humans." Explanation: Four DNA viruses have been implicated in human cancers: the human papillomavirus (HPV), Epstein-Barr virus (EBV), hepatitis B virus (HBV), and human herpesvirus 8 (HHV-8). Bacteria have not been linked with cancer and viruses do not account for a large proportion of cancer cases. HIV is associated with an increased risk of cancer caused by HHV-8, but HIV itself does not cause cancer.

The nurse is providing health education to a client recently diagnosed with a brain tumor. During the appointment, the client states, "I'm really worried that I will have a seizure while I am at work or with my kids. Should I be concerned about this?" How should the nurse respond?

"There is a risk for seizures in people who have this diagnosis. What have you already discussed with your primary health care provider regarding management of seizures?" Explanation: In this case, the client is verbalizing a valid concern about management of the potential manifestation of the brain tumor. The nurse should engage the client by providing fact-based information about the probability of seizures caused by effects of brain tumors. The nurse should further engage in the discussion by evaluating the client's existing understanding of the seizures related to brain tumors and the associated management of this problem. The open-ended manner in which the nurse has asked the question in the correct answer option allows the client to reveal any knowledge deficits or gaps in understanding of the condition. Telling the client there is a strong chance that he or she will have a seizure is countertherapeutic and would serve to increase the client's anxiety. The nurse's aim should be to reduce the client's anxiety related to the diagnosis. Telling the client that seizures are a genetic neurological condition is out of context in this situation. The client is worried about having a seizure because he or she has a brain tumor. The nurse should address the concern in the correct context. The nurse is incorrect when stating having this discussion is not within the nurse's scope of practice. The client's verbalized concern presents an opportunity for the nurse to evaluate the client's understanding of the treatment and management of the condition. The nurse should refer the client back to the primary health care provider if there are any aspects of the client's health history that are unclear.

A client has been diagnosed with bladder cancer and is meeting with the interdisciplinary team to determine a course of treatment. The client's disease is believed to be treatable with targeted cancer therapies. What should the client be taught about this form of cancer treatment?

"This treatment has far less of an effect on healthy cells than chemotherapy or radiotherapy." Explanation: Targeted cancer therapy uses drugs that selectively attack malignant cells while leaving normal cells unharmed. This stands in sharp contrast to radiation therapy and chemotherapy, which have profound effects on healthy body cells. Targeted therapies do not guarantee quick results and there is no promise of future prevention. Targeted therapies address the activity of cancer cells directly rather than influencing the immune system.

The family member of a client with terminal metastatic cancer who is experiencing cachexia-related weight loss asks the nurse why the client is losing weight despite taking in a large amount of calories per day. What is the nurse's best response?

"This weight loss is related to the cancer itself and occurs despite an intake of adequate calories." Explanation: The nurse should take the opportunity to educate the family member about the condition of cachexia-associated weight loss. This type of weight loss and protein wasting is not directly related to nutritional intake and is not simply lack of digestion of nutrients. Oral or parenteral nutritional supplementation does not reverse cachexia, so the nurse should not imply this by encouraging the family member to bring in food from home or starting tube feeding.

The physician is attending to a 72-year-old client with a malignant brain tumor. Family members report that the client rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician?

Add haloperidol to the client's treatment plan. Explanation: Haloperidol may reduce hallucinations. Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present, and it can be used prophylactically to prevent spread. Biopsy is used to analyze the lymph nodes or to destroy the tissues surrounding the tumor.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?

Adjuvant therapy is likely. Explanation: T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care?

Advice for the family to have fruit juices readily available at the client's bedside. Explanation: To promote nutrition in the terminally ill, the nurse would encourage the family to have fruit juices and milkshakes readily available at the bedside so that the client can access them frequently. Cool foods may be better tolerated than hot foods. Cheese, eggs, peanut butter, mild fish, chicken, and turkey are often better choices than meat such as beef that may taste bitter and unpleasant. Meals should be scheduled when family members are present to provide company and stimulation.

A 67-year-old client is admitted for diagnostic studies to rule out cancer. The patient is white, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? Select all that apply.

Age Cigarette smoking Occupation Explanation: Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in Black men remain substantially higher than those among White men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans (Fontham et al., 2009). Smoking is strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia. Marital status is not associated with risk for cancer.

A nurse is teaching a group of clients about causes/risk factors for cancer, which include which factors? Select all that apply.

Age Environment Genetics Heredity Explanation: The cause or causes of cancer can be viewed from two perspectives: (1) the genetic and molecular mechanisms that characterize the transformation of normal cells into cancer cells and (2) the external and more contextual factors such as age, heredity, and environmental agents that contribute to its development and progression. Financial status does not influence risk factors.

The nurse is caring for a client who has had a nuclear scan to aid in the diagnosis of possible cancer. The scan showed a "hot spot". What does this mean?

An area of increased concentrations of the tracer used in the scan. Explanation: Nuclear Scans: Clients ingest or receive intravenous (IV) radioisotopes (also known as tracers). After specific time intervals, images are taken of tissues that are affected by cancer or other diseases; the images distinguish tissues or portions of tissues that absorb more or less of the tracer. "Hot spots" show on an image of a tumor that has increased concentrations of the tracer, whereas "cold spots" can be the image of a tumor that has decreased concentration of the tracer. Options B, C, and D are incorrect information about hot spots.

A client with a terminal illness has feelings of rage toward the nurse. According to Kubler-Ross, the client is in which stage of dying?

Anger Explanation: Anger includes feelings of rage or resentment. Denial includes feelings of isolation. Bargaining occurs when a client and/or family pleads for more time to reach an important goal. Depression includes sadness, grief, and mourning for an impending loss.

A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client?

Ask about the client's bowel pattern. Explanation: Opioids can result in delayed gastric emptying, slowed bowel motility, and decreased peristalsis, all of which result in slow-moving, hard stool that is difficult to pass. Constipation is a very common side effect of narcotics and can continue to be a problem, even with chronic administration. Although respiratory depression, decreased level of consciousness, and hypotension are common side effects of acute use of narcotics, these effects are not expected to occur with chronic use at the same dose.

A client with cancer is receiving chemotherapy and reports to the nurse that his or her mouth is painful and has difficulty ingesting food. What actions should the nurse take? Select all that apply.

Asks the client to open his or her mouth to facilitate inspection of the oral mucosa Instructs the client to brush the teeth with a soft toothbrush Consults with the healthcare provider about use of nystatin Explanation: The description of the client's report is stomatitis following chemotherapy treatment. The nurse should assess the oral mucosa based on the client's report of pain and difficulty eating. The client is to use a soft toothbrush to minimize trauma to the mouth. Nystatin (Mycostatin) is a topical medication that may provide healing for the client's mouth. The client avoids alcohol-based mouthwashes as these are irritants. Flossing the teeth may cause additional trauma to the mouth.

The nurse is caring for a 90-year-old male who has never completed an advanced directive. The man has a son but has not seen him in several years. A neighbor has assisted him with meals and housecleaning for many years. The neighbor states that the client expressed only wanting to have comfort measures. The estranged son wants his father to be treated aggressively. Which would be the nurse's initial step?

Assess the client's ability to state wishes. Explanation: It cannot be assumed that the client is unable to make his own decisions just because of his advanced age. Before any other person is asked about the client's wishes, the client needs to be asked first. The physician, who has a healthcare relationship with the client, may also have documented information about wishes.

A client with acute myeloid leukemia has been receiving mitoxantrone IV as part of the chemotherapeutic regimen. When assessing the client for the effects of bone marrow suppression, the nurse should perform what assessment?

Assessment of the client's activity tolerance and energy level Explanation: The decrease in red cells that accompanies bone marrow suppression causes fatigue. Effects of bone marrow suppression on respiratory status, kidney function and electrolytes are not as common or direct, though many antineoplastics affect these domains

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

Autologous Explanation: 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.

Which of the following advice does the nurse offer clients who are undergoing unsealed radiation therapy to reduce exposure?

Avoid kissing and sexual contact. Explanation: Clients who are undergoing unsealed radiation therapy are advised to avoid kissing and sexual contact. Clients are encouraged to drink plenty of fluids to help flush radioactive substances. Client may be asked to apply mild moisturizers and are not asked not to eat after the therapy.

Which intervention should a nurse perform during the grieving period when caring for a dying client?

Avoiding criticizing or giving advice Explanation: The nurse should listen in a nonjudgmental manner and should avoid criticizing or giving advice during the grieving period when caring for dying clients. Allowing a period of privacy is necessary to help family members cope with the death of a client and is not necessary during the grieving period. Spending time with the client and providing palliative care are not the required nursing interventions during the grieving period. Palliative care is provided to a dying client when the client is unable to live independently.

Which of the following instructions would be most appropriate for a patient who is receiving temsirolimus?

Avoiding grapefruit juice Explanation: Although rest, fluids, and nutrition are important for any patient receiving an antineoplastic, a patient receiving temsirolimus needs to avoid grapefruit juice because of possible drug-food interaction.

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan?

Avoiding using soap on the irradiated areas Explanation: Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed

A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the woman has recently been taking tamoxifen. The nurse is justified in concluding that the woman has a history of what malignancy?

Breast cancer Explanation: Tamoxifen is an antiestrogen that has been widely used to prevent recurrence of breast cancer after surgical excision in women aged 40 years and older and to treat metastatic breast cancer in postmenopausal women with estrogen receptor-positive disease. Tamoxifen is not effective in preventing recurrence of any of the other options since none of those are estrogen-positive diseases.

The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurse's interview with the client, she admits that she drinks around 600 mL (20 oz) of vodka every evening. What types of cancer does this put her at risk for? Select all that apply.

Breast cancer Esophageal cancer Liver cancer Explanation: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.

When a nurse asks a patient to describe the quality of the pain, what type of descriptive term does the nurse expect the patient to use?

Burning Explanation: When asking the patient to describe how the pain feels, the nurse should suggest to the patient descriptors such as "sharp," "shooting," or "burning," which may help identify the presence of neuropathic pain.

The nurse is caring for a client who underwent surgery to remove a spinal cord tumor. When conducting the postoperative assessment, the nurse notes the presence of a bulge at the surgical site. The nurse suspects the client is experiencing what complication from the surgery?

Cerebrospinal fluid leakage Explanation: Bulging at the incision may indicate a contained cerebrospinal fluid (CSF) leak. The site should be monitored for increasing bulging, known as pseudomeningocele, which may require surgical repair. Infection at the surgical site should be suspected if the surgical dressing is stained. The bulge does not indicate growth of secondary tumor, this can only be identified using diagnostic imaging. Impaired tissue healing would be indicated if the nurse assessed redness, swelling and warmth at the surgical site during a dressing change. The bulge at the site warrants further assessment of a postsurgical leak of CSF.

A 51-year-old client has been diagnosed with stage IV breast cancer with lung metastases. The oncologist sits down with the client/family to explain treatment options. The nurse knows that which treatment option will be discussed for her cancers?

Chemotherapy Explanation: One of the advantages of chemotherapy is that, unlike surgery and radiation, it is able to treat cancer both at the primary site and at sites of metastasis. Hormone therapy is also able to exert therapeutic effects at a more systemic level, but to a lesser degree than chemotherapy.

A nurse is providing education on treatment options to the parents of a child with cancer. The nurse should include which of the following as the most widely used treatment modality for childhood cancers?

Chemotherapy Explanation: The nurse should include that the most widely used treatment modality for childhood cancers is chemotherapy.

A nurse suspects that a client has Huntington disease based on which assessment finding?

Chorea Explanation: The most prominent clinical features of Huntington disease include chorea, intellectual decline, and often emotional disturbance. As the disease progresses, speech becomes slurred, gait becomes disorganized, and cognitive function is altered with dementia.

A client who has recently attended a talk on healthy tips for preventing cancer identifies which foods/compounds to be carcinogenic in humans? Select all that apply.

Cigarette smoke Nickel compounds Smoked foods Explanation: There are many agents known to be carcinogenic to humans, including soot, tar, cigarette smoke, arsenic compounds, nickel compounds, and smoked foods among many others.

A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client's symptoms?

Client's goals Explanation: When managing the symptoms of a client with a terminal illness, the client's goals take precedence over the clinician's goals to relieve all symptoms at all costs. Although the length and invasiveness of the treatment may influence decision making, ultimately it is the client's goals that determine what will be done.

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services?

Clients and families view hospice care as giving up Explanation: Clients often equate hospice with giving up and are reluctant to accept hospice care. Lack of fully credentialed and trained hospice nurses is not a barrier to hospice care. Lack of Medicare funding and lack of certification for hospice service providers have not been documented as barriers to access of hospice services.

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?

Closely observe the client's skin for petechiae and bruising. Explanation: The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?

Control Explanation: The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.

A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply.

Control the client's pain with prescribed medication. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes. Explanation: This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation. Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse's role to suggest physician-assisted suicide voluntarily, however.

The nurse educator knows which statement about pituitary adenomas is true?

Cushing disease can result from a functioning tumor. Explanation: Endocrine disorders can result from the existence of functioning pituitary adenomas. These tumors cause the production of hormones at the anterior pituitary and there may be an increase in various hormones, including cortisol that is responsible for the development of Cushing disease. Pituitary adenomas are rarely seen in the pediatric population. Most pituitary adenomas are benign tumors. The incidence of pituitary adenoma tumors is higher in women than men.

The drug interleukin-2 is an example of which type of biologic response modifier?

Cytokine Explanation: Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?

Excisional biopsy Explanation: Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.

A parent hears the health care provider using the word extravasation. The parent asks the nurse what extravasation means. What would be a correct answer?

Extravasation is when fluid escapes from a blood vessel into the surrounding tissue." Explanation: Extravasation is the escape of fluid from a blood vessel into surrounding tissues. Blood vessels are not cut for this to happen. Edema is when fluid is pooled in one area of the body. Extravasation is not a disease. In some types of shock, extravasation occurs.

A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, "What gives your life meaning?" The nurse is assessing which of the following?

Faith and belief Explanation: The question about what gives life meaning provides information about the client's faith and belief. Importance and influence are addressed by questions focusing on the role faith plays in the client's life and how his or her beliefs affect the way the client cares for self and illness. Community is addressed by questions focusing on the client's participation in a spiritual or religious community and the support obtained from it. Address in care focuses on how the nurse would integrate the issues involving spirituality in the client's care.

The nurse is planning care for a client who is receiving antimetabolite chemotherapy. What should the nurse include in the plan of care? Select all that apply.

Falls prevention protocol Daily weights Monitor bowel movements closely. Explanation: Common side effects when taking an antimetabolite include stomatitis, diarrhea, and myelosuppression. The nurse should monitor bowel movements due to the risk for diarrhea and for possible gastrointestinal blood loss related to thrombocytopenia and mucosal injury, which affect the S phase of the cell cycle. Due to this increased risk for bleeding, falls prevention is also important. While stomatitis would make a soft diet appropriate, fresh fruits and vegetables can introduce microbes that could be harmful for the immunocompromised client. Due to this increased risk for infection, an indwelling catheter is not recommended. Daily weight can help determine total body water and is recommended due to the risk for decreased intake and increased losses for these clients, placing them at risk for fluid volume deficit.

A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply.

Financial pressures on health care providers Client reluctance to accept this type of care Advances in "curative" treatment in late-stage illness Explanation: Physicians are reluctant to refer clients to hospice, and clients are reluctant to accept this form of care. Reasons include the difficulties in making a terminal prognosis (especially for those clients with noncancer diagnoses), the strong association of hospice with death, advances in "curative" treatment options in late-stage illness, and financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible clients.

Which clinical assessment findings can be considered an adverse effect to the radiation treatment the client is undergoing to "shrink" a tumor prior to surgery? Select all that apply.

Hemoglobin 9.0 g/dL (90 g/L)(low) Complains of frequent nauseas and vomiting Explanation: To some extent, radiation is injurious to all rapidly proliferating cells, including those of the bone marrow and the mucosal lining of the gastrointestinal tract. This results in many of the common adverse effects of radiation therapy, including infection, bleeding, and anemia due to loss of blood cells and nausea and vomiting due to loss of gastrointestinal cells.

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition?

Hemorrhagic stroke Explanation: Brain angiomas (masses composed largely of abnormal blood vessels) are found either in the brain or on its surface. Because the walls of the blood vessels in angiomas are thin, affected clients are at risk for hemorrhagic stroke. Pituitary adenomas that produce hormones can lead to endocrine disorders, such as thyroid disorders. In addition, they can exert pressure on the optic nerves and optic chiasm, leading to vision loss. Acoustic neuromas are associated with hearing loss.

A nurse doing a presentation on cancer to a local community group identifies which factors to be high-risk and associated with cancer development? Select all that apply.

Heredity Hormonal factors Environmental agents Immunologic mechanisms Explanation: Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunologic mechanisms, and environmental agents. Obesity has also been suggested to a factor.

A 26-year-old man with testicular cancer is prescribed combination chemotherapy that involves using two drugs that are effective against testicular tumors. Combination drug therapy is superior to single-drug therapy because of

Higher tumor response rates Explanation: Combination therapy is considered superior over single-drug therapy because of higher tumor response rates and increased, not decreased, duration of remissions. Combination therapy does not pose a lower risk for secondary cancers, and increased capillary permeability is not the reason for the preference of combination therapy over monotherapy.

A client's chemotherapeutic regimen includes procarbazine. What is the client's most likely diagnosis?

Hodgkin lymphoma Explanation: Procarbazine (Matulane) is used in combination therapy for treatment of stages III and IV of Hodgkin disease.

It is well known that cancer is not a single disease. It follows then that cancer does not have a single cause. It seems more likely that the occurrence of cancer is triggered by the interactions of multiple risk factors. What are some identified risk factors for cancer?

Hormonal factors, chemicals, and immunologic mechanisms Explanation: Cancer occurs because of interactions among multiple risk factors or repeated exposure to a single carcinogenic (cancer-producing) agent. Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunologic mechanisms, and environmental agents such as chemicals, radiation, and cancer-causing viruses. More recently, there has been interest in obesity and type 2 diabetes mellitus as risk factors for a number of cancers. Body type, age, and color of skin have not been identified as risk factors for cancer.

A male client is diagnosed with prostate cancer. The treatment modality of choice includes both surgery and chemotherapy. What does the chemotherapeutic option include?

Hormonal therapies Explanation: Hormonal therapies that block the effects of estrogen (in an estrogen-responsive tumor) and androgen (in an androgen-responsive tumor), respectively, are essential in the treatment of breast and prostate cancers.

A nursing instructor is preparing a class discussion about hope and end-of-life care. Which of the following would the instructor include as an example of a hope-fostering activity?

Humor Explanation: Hope-fostering categories include love of family and friends, spirituality and faith, goal setting, maintenance of independence, positive relationships with clinicians, humor, personal characteristics, and uplifting memories. Hope-hindering categories include abandonment, isolation, uncontrollable pain or discomfort, and devaluation of personhood.

Which disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive, involuntary dancelike movements and dementia?

Huntington disease Explanation: Because it is transmitted as an autosomal dominant genetic disorder, each child of a parent with Huntington disease has a 50% risk of inheriting the illness. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Parkinson disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

The health care provider is assessing a client with cancer for the possibility of endocrine disorders. This client would be assessed for which manifestations of an endocrine disorder? Select all that apply.

Hypercalcemia Syndrome of inappropriate antidiuretic hormone (SIADH) Cushing syndrome Explanation: The three most common endocrine syndromes associated with cancer are the syndrome of inappropriate ADH secretion, Cushing syndrome due to ectopic ACTH production (see Chapter 32), and hypercalcemia. Hypercalcemia also can be caused by osteolytic processes induced by cancer such as multiple myeloma or bony metastases from other cancers. The other options do not occur.

A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis?

Imbalanced nutrition: less than body requirements Explanation: Nausea and vomiting are major threats to the client's nutrition. Failure to thrive is typically a chronic, rather than acute, health problem. Pain does not necessarily accompany nausea, and there is no indication that this client is not maintaining the necessary regimen.

A client received a liver transplant and is now taking immunosuppressant medication. The client has been told that a potential side effect of the therapy is the development of cancer. Select the option that best supports this information.

Immune surveillance hypothesis Explanation: The immune surveillance hypothesis suggests that the development of cancer might be associated with impairment or decline in the surveillance capacity of the immune system. Increases in cancer incidence have been observed in people with immunodeficiency diseases and in those with organ transplants who are receiving immunosuppressant drugs. The other options will not cause immunosuppression.

Because an adolescent has revealed a history of childhood cancer, the nurse should include in the plan of care an assessment for which late-therapy sequelae? Select all that apply.

Impaired growth Neurologic dysfunction Hormonal dysfunction Explanation: The nurse should include assessment for late-therapy sequelae, including impaired growth, neurologic dysfunction, pulmonary fibrosis, hormonal dysfunction, cardiomyopathy, and risk for secondary malignancies.

A nurse is providing care to a client who has been diagnosed with metastatic brain cancer. When developing the client's plan of care, which outcome would the nurse most likely identify?

Improved quality of life Explanation: The treatment of metastatic brain cancer is palliative and involves eliminating or reducing serious symptoms. Even when palliation is the goal, distressing signs and symptoms can be relieved, thereby improving the quality of life for both client and family. Removal of all or part of the tumor is the goal of surgery. Radiation therapy attempts to decrease the incidence of recurrence of incompletely resected tumors.

A nurse assesses a patient who has been diagnosed with having a pituitary adenoma that is pressing on the third ventricle. The nurse looks for the associated sign/symptom. What is that sign/symptom?

Increased intracranial pressure Explanation: All the choices are signs and symptoms that can occur with an adenoma, depending on whether the pressure is exerted on the hypothalamus, the third ventricle, or the optic nerves, chiasm, or tracts. Increased intracranial pressure occurs when the third ventricle is affected.

A client is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim may aid in achieving what desired outcome?

Increased leukocytes Explanation: Severe neutropenia can be prevented or its extent and duration minimized by administering filgrastim or sargramostim to stimulate the bone marrow to produce leukocytes. Filgrastim does not address the risk of inflammation (mucositis), abnormal platelet production, or bleeding (hemorrhagic cystitis).

When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?

Inspect the skin frequently. Explanation: Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?

Inspecting the skin for petechiae once every shift Explanation: Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following?

Irritation of the medullary vagal centers Explanation: Vomiting associated with a brain tumor is usually the result of irritation of the vagal centers in the medulla. Edema secondary to the tumor or distortion of the pain-sensitive structures is thought to be the cause of the headache associated with brain tumors. Compression of the surrounding structures results in the signs and symptoms of increased intracranial pressure.

A client has been diagnosed with cancer that was a result of dysfunctional apoptosis. The health care provider explains the process to the multidisciplinary client care team. Select the best explanation.

It allows for DNA-damaged cells to survive. Explanation: Apoptosis is considered a normal cellular response to DNA damage; loss of normal apoptotic pathways may contribute to cancer by enabling DNA-damaged cells to survive

A female client is ending an extensive chemotherapeutic regimen that included cytotoxic antineoplastic drugs. What does the nurse understand about bone marrow toxicity in this client?

It is a common adverse effect of her treatment. Explanation: Traditional cytotoxic antineoplastic drugs are nonselective in their effect on proliferating cells; therefore, bone marrow toxicity is a common adverse effect of many cytotoxic drugs. These drugs kill the same fraction of cells with each cycle of chemotherapy treatment; repeated cycles of cytotoxic drugs potentially lower the number of cancer cells to a level where a person's immune responses are able to take over and destroy the remaining cancer cells.

Bone density testing will be completed for the client with post-polio syndrome. The nurse teaches the client bone density testing is used to identify what potential complication?

Low bone mass and osteoporosis Explanation: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families.

In some cancers, the presenting factor is an effusion, or fluid, in the pleural, pericardial, or peritoneal spaces. Research has found that almost 50% of undiagnosed effusions in people not known to have cancer turn out to be malignant. Which cancers are often found because of effusions?

Lung and ovarian cancers Explanation: Lung cancers, breast cancers, and lymphomas account for about 75% of malignant pleural effusions. Reports of abdominal discomfort, swelling, and a feeling of heaviness and an increase in abdominal girth, which reflect the presence of peritoneal effusions or ascites, are the most common presenting symptoms in ovarian cancer, occurring in up to 65% of women with the disease

The nursing student who is studying about cancer correctly identifies which type to be the leading cause of cancer death in both men and women?

Lung cancer Explanation: The leading cause of death in both men and women is lung cancer. Breast cancer leads death in women, whereas prostate cancer is the leading cause of death in men

You are presenting a class on cancer for a local community group. You inform the attendees that chemical agents in the environment are believed to account for 75% of all cancers. Which organs are most susceptible to cancer caused by these chemical agents?

Lungs, liver, and kidneys Explanation: The lungs, liver, and kidneys are affected mostly because they are involved with biotransformation and excretion of chemicals.

A client with spinal cord compression from a tumor must undergo diagnostic testing. Which of the following is the most likely procedure for this client?

Magnetic resonance imaging Explanation: Magnetic resonance imaging is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases.

Which of the following is the nurse's primary concern when providing end-of-life care for a client and the family? Select all that apply.

Maintaining client comfort Supporting family members Providing personal care Explanation: Nursing care of dying clients focuses on providing palliative care to the client and supporting family members. Arranging the plans after death is not a priority at this time. Completing a head-to-toe assessment may be completed for information but is not a priority at the end of life. There is no need to encourage fluids.

A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance?

Make sure the client is sitting with the head of bed elevated to 90 degrees. Explanation: Clients with Parkinson's disease are at risk for aspiration; therefore, the nurse should instruct the ancillary staff member to make sure the head of the client's bed is elevated to 90 degrees before assisting the client with eating. A client doesn't always cough when he aspirates. A client with Parkinson's disease needs fluids to maintain fluid balance. Aspiration is a great concern with Parkinson's disease; therefore; the staff should take precautions to prevent this complication.

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest?

Malignant tumor Explanation: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.

A male client is informed that the latest tests indicate that his cancer has spread to his liver. The client receives capecitabine as part of his treatment regimen. What would the nurse expect the health care provider to do?

Monitor the client closely and repeat LFTs routinely. Explanation: Capecitabine blood levels are significantly increased with hepatic impairment, and clients with liver metastases should be monitored closely

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant?

Monitor the client closely to prevent infection. Explanation: Until transplanted stem cells begin to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.

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. Explanation: 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.

Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise?

Mutual pretense awareness Explanation: In mutual pretense awareness, the client, the family, and the health care professionals are aware that the client is dying, but all pretend otherwise. In closed awareness, the client is unaware of his or her terminal state, whereas others are aware. In suspected awareness, the client suspects what others know and attempts to find it out. In open awareness, all are aware that the client is dying and are able to acknowledge that reality openly.

Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues?

Neoplasm Explanation: An abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues is called a neoplasm. A transformation occurs when a cell has become cancerous. A mutation is an alteration in the DNA that may or may not result in a transformation. An insertion is a type of mutation.

Which type of surgery is used in an attempt to relieve complications of cancer?

Palliative Explanation: Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.

The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using?

Palliative care Explanation: Long-term care is increasing as a setting to provide palliative care that addresses management of symptoms such as pain. Inpatient respite care is a 5-day inpatient stay provided on an occasional basis to relieve the family caregivers. Continuous care is provided in the home to manage a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.

A group of nursing students is reviewing information about palliative care. The students demonstrate a need for additional review when they identify which of the following?

Palliative care is the same as hospice care. Explanation: Palliative care is not synonymous with hospice care. All hospice care is palliative but not all palliative care is hospice care. Palliative care is conceptually broader than hospice care and is an approach to care as well as a structured system for delivering care. Palliative care followed the development of hospice care. It does not begin when cure-focused treatment ends but is most helpful when provided along with disease-remitting treatment.

A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms?

Parkinson's disease Explanation: Early signs include stiffness, referred to as rigidity, and tremors of one or both hands, described as pill-rolling (a rhythmic motion of the thumb against the fingers). The hand tremor is obvious at rest and typically decreases when movement is voluntary, such as picking up an object. Bradykinesia, slowness in performing spontaneous movements, develops. Clients have a masklike expression, stooped posture, hypophonia (low volume of speech), and difficulty swallowing saliva. Weight loss occurs. A shuffling gait is apparent, and the client has difficulty turning or redirecting forward motion. Arms are rigid while walking. These symptoms are not indicative of MS, Myasthenia gravis, or Huntington's.

A nurse is caring for a client with a terminal illness. The client asks the nurse to help him end his own life to alleviate his suffering and that of his family. When responding to the client, the nurse integrates knowledge of which of the following?

Participating in assisted suicide violates the Code of Ethics for Nurses. Explanation: The American Nurses Association Position Statement on Assisted Suicide acknowledges the complexity of the assisted suicide debate but clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. Legally, nurses are not allowed to administer medications even if prescribed by a physician if that medication will hasten the client's end of life. Proponents of physician-assisted suicide argue that terminally ill people should have a legally sanctioned right to make independent decisions about the value of their lives and the timing and circumstances of their deaths. However, this is not the case at the present time. Two states have enacted legislation for physician-assisted suicide. These laws provide access to physician-assisted suicide by terminally ill clients under very controlled circumstances.

A big difference in the treatment of childhood cancer as opposed to adult cancer is that chemotherapy is the most widely used treatment therapy for childhood cancer. What is the reason for this?

Pediatric tumors are more responsive to chemotherapy than adult cancers. Explanation: Chemotherapy is more widely used in the treatment of children with cancer than in adults because children better tolerate the acute adverse effects, and in general, pediatric tumors are more responsive to chemotherapy than adult cancers. Children are very adaptable and tolerate more forms of cancer treatment than adults do. Children do complain about the nausea and vomiting chemotherapy can cause, just like adults do, and they do not like losing their hair, just like adults.

Which phase of pain transmission occurs when the brain experiences pain at a conscious level?

Perception Explanation: Perception is the phase of impulse transmission during which the brain experiences pain at a conscious level, but many concomitant neural activities occur almost simultaneously. Transmission is the phase during which peripheral nerve fibers from synapses with neurons in the spinal cord. Modulation is the last phase of pain impulse transmission, during which the brain interacts with the spinal nerves in a downward fashion to alter the pain experience. Transduction is the conversion of chemical information in the cellular environment to electrical impulses that move toward the spinal cord.

The nurse educator is teaching nursing students about various types of brain tumors. The instructor recognizes that teaching has been effective when students correctly identify a client whose lab work indicates excessively high levels of thyroid stimulating hormone would most likely be diagnosed with which type of tumor?

Pituitary adenoma Explanation: Pituitary adenomas can increased production of several hormones including TSH, ACTH, growth hormone and prolactin. Excessive hormone production is not characteristic of the brain tumors identified in the alternate options.

The nurse is caring for a client who is currently under medical investigation for a pituitary adenoma. The nurse anticipates the client will likely report which symptoms that are consistent with this type of brain tumor? Select all that apply.

Polydipsia Polyuria Disturbed sleep Impairment of visual field Explanation: Pressure from a pituitary adenoma may be exerted on the optic nerves, optic chiasm, optic tracts, hypothalamus, or the third ventricle. Headache is a common symptom; there can also be visual dysfunction including loss of visual field, the development of diabetes insipidus including symptoms such as excessive thirst and urination. Sleep disturbances are reported and result from the development of diabetes insipidus. Seizures are a common finding with angioma brain tumors.

The nurse has given an older adult an oral opioid for postoperative pain. What should the nurse do first to make the pain medication more effective?

Position the client for comfort. Explanation: The nurse should provide a comfort level with positioning first. Hydroxyzine may be given with opioid analgesics. However, elderly clients are more susceptible to adverse reactions of this medication, and alternative measures should be tried first. Providing a fresh gown will not make the medication more effective. Ingesting food with an opioid medication does not make the medication more effective.

A client comes to the clinic reporting low back pain and muscle spasms. He states, "The pain seems to travel into my hip and down to my leg." A herniated lumbar disk is suspected. Which of the following would help to confirm the suspicion? Select all that apply.

Postural deformity Muscle weakness Altered tendon reflexes Explanation: A herniated lumbar disk manifests with pain aggravated by actions that increase intraspinal fluid pressure, such as bending, lifting, or straining. The problem is relieved by rest. Typically, there is a postural deformity and results of the straight leg test are positive. Muscle weakness, altered tendon reflexes, and sensory loss also are noted.

While discussing the various types of cells, the instructor points out that cells that renew constantly throughout life have specialized cells that cannot divide without which type of cell being present?

Progenitor cells that are differentiated so their daughter cells are limited to the same cell line. Explanation: In less-specialized tissues, such as the skin and mucosal lining of the gastrointestinal tract, a high degree of cell renewal continues throughout life. Even in these continuously renewing cell populations, the more specialized cells are unable to divide. Many of these cell populations rely on progenitor or parent cells of the same lineage. Progenitor cells are sufficiently differentiated so that their daughter cells are limited to the same cell line, but they have not reached the point of differentiation that precludes the potential for active proliferation.

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease?

Prostate cancer Explanation: In male patients, antiandrogens are used to treat prostate cancer. They are not included in treatment of lymphomas, skin cancer, or lung cancer.

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth?

Provide gentle oral care after each meal. Explanation: Dry mouth can generally be managed through nursing measures such as mouth care. The use of artificial hydration (IV fluids) carries considerable risks and does not contribute to comfort at the end of life. Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions. Gentle oral suctioning reduces the production of secretions.

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?

Provide time for the patient to discuss her concerns. Explanation: Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery. The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse's response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another.

A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply.

Provides pain relief Integrates spirituality Offers a team approach to care Enhances quality of life Explanation: The principles of palliative care include providing relief from pain and distressing symptoms. In the early course of disease, chemotherapy and radiation may be used to define care needed, but in the later stages, chemotherapy is typically not used. Psychological support including spirituality and bereavement counseling for family members is available. The care does not hasten nor postpone death but is aimed at enhancing a quality of the life that is remaining. A team approach meets the needs of the client and family.

The nurse is caring for a client with metastatic brain cancer. The client will be receiving palliative treatment. The nurse should anticipate what type of medical management will be included in the client's care? Select all that apply.

Radiosurgery Craniotomy with debulking Radiation Explanation: When the prognosis for any brain tumor is poor, the palliative care approach is used to guide the management of symptoms with the aim of increasing client comfort and decreasing distressing symptoms as much as possible. This can include surgical debulking of the tumor, which requires a craniotomy. Treatment using radiosurgery provides a very high dose of radiation to a very small precise area to decrease tumor size to prevent a rise in intracranial pressure. These treatment techniques are known as Gamma Knife or Cyberknife. Simple radiation is also used to decrease the size of the tumor in a less invasive way than surgery. The aim of this treatment is also to increase comfort and prolong life by decreasing pressure on surrounding brain structures and intracranial pressure. The alternate answer options list diagnostic techniques that would only be used when imaging of the tumor is required for diagnosis to plan treatment.

A client reports a new onset of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. The health care provider orders a diagnostic workup, which reveals end-stage gallbladder cancer. What nursing intervention should be used to facilitate adaptive coping?

Refer client for professional counseling. Explanation: Referring the client for professional counseling will facilitate adaptive coping. Encouraging ventilation of negative feelings will allow for emotional expression, but may not facilitate coping. Physical well-being will increase self-esteem, but won't necessarily help the patient cope with the diagnosis. Providing written education is for client teaching, not to facilitate coping

A woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply.

Reinvesting in new relationships at the appropriate time Reminiscing about the relationship she had with her husband Relinquishing old attachments to her husband at the appropriate time Explanation: Six key processes of mourning allow people to accommodate to the loss in a healthy way:1.) Recognition of the loss2.) Reaction to the separation, and experiencing and expressing the pain of the loss3.) Recollection and re-experiencing the deceased, the relationship, and the associated feelings4.) Relinquishing old attachments to the deceased5.) Readjustment to adapt to the new world without forgetting the old6.) Reinvestment Reiterating her anger and renewing her lifelong commitment may be counterproductive to the mourning process.

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen?

Risk for Infection related to bone marrow suppression Explanation: Like many cancer treatments, imatinib causes bone marrow suppression that creates a consequent risk of infection. The drug does not typically result in cognitive changes, fluid overload, or skin breakdown.

The nurse is seeing a client for follow up after chemotherapy in the outpatient clinic. The client states, "Over the last week, I've been losing handfuls of my hair in the shower. I don't want to shave my head but I don't want people to stare at me either." Based on the client's statement, what should the nurse include in the client's care plan? Choose the best answer.

Risk for disturbed body image Explanation: The physical changes caused by treatment of brain tumors can be distressing for clients. Alopecia and weight loss are commonly associated with chemotherapy treatment. The client who is concerned about body image changes such as losing "handfuls of hair" is at risk for body image disturbance, and the nurse should include this in the care plan. Although the client may be experiencing anxiety related to the bodily changes taking place, the statement made is reflective of body image disturbance. There is no evidence in the client's statement that there is a knowledge or self-care deficit.

The nurse is providing home care to a dying client and has noticed over the course of several weeks that the client's daughter is usually quiet and withdrawn when in the client's room. Which intervention should the nurse perform in this situation?

Sit with the client's daughter privately and encourage her to express her feelings frankly. Explanation: Failure to verbalize feelings, express emotions, and show tenderness for the dying person is often a source of regret for grieving relatives. Therefore, families must feel that they can express their feelings with nurses who are compassionate listeners. If nurses encourage family members and listen to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying client. Families must feel that they can express their feelings with nurses who are compassionate listeners. Reminding a family member that their loved one will die soon shows a lack of compassion in this situation. Although the client is the nurse's main priority, it is the nurse's role to encourage family members to identify strengths and express feelings as a method of coping with the death of their loved one. The response regarding making the father's final days happy ones shows a lack of caring on the part of the nurse.

A client's oncologist has presented the possibility of implementing biotherapy in the treatment of the client's brain tumor. Which mechanisms of action provide the therapeutic effects of biotherapy? Select all that apply.

Stimulating the immune response to tumor cells Inhibiting tumor protein synthesis Explanation: Biotherapy exerts therapeutic effects by way of altering host responses (such as by stimulating the immune response) or by inhibiting tumor cell biology (e.g., inhibiting protein synthesis). Biotherapy does not reverse existing angiogenesis, and the hormonal environment is not a particular focus of biotherapy. Radiation is the primary means by which breaks in tumor DNA are made.

The nurse is administering a client's chemotherapeutic drug through a peripheral IV site, and the nurse observes that extravasation has occurred. What is the nurse's best action?

Stop the infusion and inform the health care provider immediately. Explanation: Extravasation should prompt the nurse to stop the infusion and collaborate promptly with the care provider. A bolus would cause more harm than benefit by distributing the drug in compromised tissue. Monitoring is not a sufficient response, and another IV site may or may not be needed.

A nurse is providing care to a client recently diagnosed with a brain tumor. When planning this client's care, the nurse anticipates which therapy as providing the best outcome for the client?

Surgery Explanation: A variety of medical treatment modalities, including chemotherapy and external-beam radiation therapy, radiosurgery, or radiotherapy are used alone or in combination with surgical resection. However, surgical intervention provides the best outcome for most brain tumor types.

What nursing intervention will best help the client with Huntington disease to increase nutrition? Select all that apply.

Take phenothiazine prior to meals Explanation: Talking to the client before meals will help to promote relaxation, and phenothiazines help to calm some clients. Eliminating foods high in fat, increasing carbohydrates, and pureeing food will not assist in relaxing muscles during choreiform movements. The nurse should wait for the client to chew and swallow, which can be a slow process.

A client is scheduled for a bronchoscopy related to a history of "bronchitis" for the last 3 months that has been unresponsive to antibiotics. The nurse shares with the client that a primary purpose for this bronchoscopy is to help diagnose which complication?

Taking tissue biopsy and looking for abnormal cells Explanation: Tissue biopsy involves the removal of a tissue specimen for microscopic study. It is of critical importance in designing the treatment plan should cancer cells be found. Biopsies are obtained in a number of ways, including needle biopsy; endoscopic methods, such as bronchoscopy or cystoscopy, which involve the passage of an endoscope through an orifice and into the involved structure; and laparoscopic methods.

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug?

Tamoxifen Explanation: Anti-estrogens are first-line therapy for treating breast cancer in postmenopausal women. Tamoxifen is the most widely recognized anti-estrogen.

A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client

That medication will be prescribed for pain relief Explanation: Pain is expected postoperatively, and the client should be reassured that medication will be prescribed to relieve pain. The client may have less pain knowing that measures will be taken to reduce it. Diversional activities may be used in addition to analgesics. Anxiety about pain could increase the client's perception of pain. Another nursing activity is being an advocate for the client and notifying his surgeon of the client's fear.

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?

The I.V. site is red and swollen. Explanation: A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time.

A client overheard the provider discussing the case and mentioning a "mutation in the TP53 gene." The client asks the nurse, "What does that mean?" Which response is appropriate for this client?

The TP53 gene is a tumor suppressor gene associated with lung, breast and colon cancer." Explanation: Multiple tumor suppressor genes have been found that connect with various types of cancer. Of particular interest in this group is the TP53 gene, which is on the short arm of chromosome 17 and codes for the p53 protein. Mutations in the TP53 gene have been associated with lung, breast, and colon cancer. The TP53 gene also appears to initiate apoptosis in radiation- and chemotherapy-damaged tumor cells. The statement does not mean the gene was damaged in embryo and exposed to a toxin. Not all cancers result from an abnormality in some gene or chromosome. A monoclonal antibody is an antibody produced by a single clone of cells or cell line and consisting of identical antibody molecules. It is different from a mutation in a certain gene pool.

A client has undergone extensive diagnostic testing and has been diagnosed with breast cancer staged as T3, N0, M0. What conclusion can the nurse draw from the staging of the client's breast cancer?

The client has a sizable tumor but there is no lymphatic involvement. Explanation: This client's staging indicates a tumour of significant size but no evidence of lymph node involvement or metastasis. The "3" in "T3" does not denote a specific size of 3 mm, however. Metastasis is not currently present, but this does not mean that it is not a future possibility if left untreated.

Which client should the nurse assess for degenerative neurologic symptoms?

The client with Huntington disease. Explanation: Huntington disease is a chronic, progressive, degenerative neurologic hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. Paget disease is a musculoskeletal disorder, characterized by localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae. Osteomyelitis is an infection of the bone. Malignant glioma is the most common type of brain tumor.

The client has just been started on an alkylating agent to treat testicular cancer. What assessment finding would suggest that the client is experiencing a common adverse effect of this medication?

The client's most recent laboratory results indicate pancytopenia. Explanation: Hematological effects include bone marrow suppression, with leukopenia, thrombocytopenia, anemia, and pancytopenia, secondary to the effects of the drugs on the rapidly multiplying cells of the bone marrow. Bone pain, depression, and disorientation are not common adverse effects of alkylating agents.

A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client's hemostatic function?

The client's platelet count will decline. Explanation: Thrombocytopenia, not thrombocytosis, is a common adverse effect of cytotoxic chemotherapy. Heparin is consequently contraindicated, and DVT is not a priority risk.

Select the option that best describes metastasis.

The development of a secondary tumor. Explanation: Metastasis describes the development of a secondary tumor in a location distant from the primary tumor. Seeding of cancer cells into body cavities occurs when a tumor erodes and sheds cells into these spaces. Cancer is described as crablike because it grows and spreads by sending crablike projections into the surrounding tissues. Lymphatic spread is the presence of tumor cells in the lymph nodes that drain the tumor area.

A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following?

The disease has entered the late stages. Explanation: In late stages, the disease affects the jaw, tongue, and larynx; speech is slurred; and chewing and swallowing become difficult. Rigidity can lead to contractures. Salivation increases, accompanied by drooling. In a small percentage of clients, the eyes roll upward or downward and stay there involuntarily (oculogyric crises) for several hours or even a few days. Options A, B, and C are therefore incorrect.

What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect?

The drug will be effective through all phases of the cell cycle. Explanation: Drugs that are effective through all phases of the cell cycle and not limited to a specific phase are classified as cell cycle-nonspecific.

Which of the following does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first. Explanation: The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.

A client with Hodgkin disease has been prescribed vincristine. What nursing consideration should the nurse prioritize when administering this drug?

The nurse should avoid any skin, eye, or mucous membrane contact with the drug. Explanation: Special care needs to be taken when administering mitotic inhibitors. The nurse should avoid any skin, eye, or mucous membrane contact with the drug. This type of contact can cause serious reactions and toxicity for the nurse. The nurse should check for extravasation frequently during the infusion and not wait until the infusion is completed. A distal vein should be use. Nausea and vomiting are commonly experienced adverse effects of these drugs. Small meals may help the client to maintain adequate nutrition, but this is not the important concern when administering the drug.

A nurse is caring for a client who has received antineoplastic therapy. The client has developed inflammation of the oral mucous membrane, which is affecting his nutritional status. Which action by the nurse would be most appropriate? Select all that apply.

The nurse should suggest that the client provide mouth care with normal saline every 4 hours and offer soft or liquid foods. Use of toothpaste, lemon or glycerin swabs, or alcohol-based mouthwash for oral care is not suggested as they cause further irritation to the oral mucosa and complicate stomatitis.

A 77-year-old male client with a diagnosis of stomach cancer has been found to have metastases in his liver. The client and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which fact would underlie the reply that the care team provides?

The portal circulatory system brings venous blood from the GI tract into the liver. Explanation: Portal circulation brings venous blood into the portal vein of the liver, facilitating hematologic spread. The parenchyma of the liver possesses no particular susceptibility to cancer. Hepatic tissue does not share traits of cancerous cells such as low contact inhibition or lack of anchorage dependence

The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?

The principle of autonomy Explanation: By promoting open discussion and informed decision making, the nurse is empowering the client to make his own decisions leading to autonomy. The principle of justice requires fairness and justice to all clients. The principle of nonmaleficence requires that nurse does not intentionally or unintentionally inflict harm on others. The principle of fidelity maintains that nurses are faithful to the care of the clients.

When describing the process of cancer cell growth to a client, the nurse addresses angiogenesis. Which description would the nurse include?

The process of creating new blood vessels to supply oxygen and nutrients to the cells Explanation: Angiogenesis refers to the process in which abnormal cells release enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells. Metastasis refers to process of traveling from the place of origin to develop new tumors in other areas of the body. Autonomy refers to the process of growing without the usual homeostatic restrictions that regulate cell growth and control. Anaplasia refers to the process in which the cells lose their ability to differentiate and organize, which leads to a loss in their ability to function normally.

When describing the term "grief" to a group of students, which of the following would the instructor include?

The response experienced by anyone who has suffered a loss Explanation: Grief refers to the universal response to any loss. It is experienced by anyone suffering any type of loss. Loss is part of the life cycle and occurs in the form of change, growth, and transition. Spirituality refers to the feeling of connectedness with self, others, a life force, or God that allows people to find meaning in life. Anxiety refers to feelings of apprehension or worry in response to or about a situation.

A 51-year-old female patient has been receiving doxorubicin for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which measure would help limit the severity of the cardiomyopathy in this client?

The use of dexrazoxane in conjunction with doxorubicin Explanation: Dexrazoxane, a cardioprotectant, is recommended to reduce the severity and incidence of cardiomyopathy associated with doxorubicin for women with metastatic breast cancer who received a cumulative dose of 300 mg/m2. Meticulous monitoring or multiplying daily doses would not reduce the severity and incidence of cardiomyopathy as effectively as using dexrazoxane, and reducing the dosage is not advisable.

A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents?

The use of three agents decreases the development of cell resistance. Explanation: Most chemotherapy regimens involve a combination of drugs with different actions at the cellular level, which destroys a greater number of cancer cells and reduces the risk of the cancer developing drug resistance. The rationale for using multiple antineoplastic agents is not accurately explained by any of the other options.

Nursing students are reviewing information about attitudes related to death and dying. The students demonstrate understanding of the information when they identify which of the following as most accurate?

There remains a conspiracy of silence about dying despite progress in the area. Explanation: Despite the progress on many fronts associated with attitudes toward death and dying, there still is a belief in a conspiracy of silence about dying. Although a growing number of clinicians are becoming more comfortable with assessing clients' and families' information needs, many still avoid the topic in the hope that the client will ask or find out on his or her own. In addition, there are misconceptions that clients would subsequently lose all hope, give up, or be psychologically harmed by disclosure of a serious or terminal illness and that clients would ask for information if they really wanted to know.

Prior to administering a dose of 5-FU to a patient with pancreatic cancer, the nurse is conducting the necessary drug research. The nurse is aware that 5-FU is a cell cycle-specific chemotherapeutic agent. Which statement best describes cell cycle-specific drugs?

They affect cancerous cells during a particular phase of cellular reproduction. Explanation: Chemotherapeutic drugs that are most effective during a particular phase of the cycle are known as cell cycle- (or cell phase) specific, whereas drugs that act independently of a specific cell cycle (or cell phase) are cell cycle-nonspecific. Not all cell cycle-specific drugs achieve a synergistic effect with cell cycle-nonspecific drugs. These drugs are not named because of the particular sequence of cytotoxic events that they cause

The nurse is seeing the mother of a client who states, "I'm so relieved because my son's doctor told me his brain tumor is benign." The nurse knows what is true about benign brain tumors?

They can affect vital functioning. Explanation: Benign tumors are usually slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. Surgical removal of a benign tumor is dependent on many factors; even if the tumor is slow growing or not growing at all, the location of the tumor in the brain factors into the decision for surgical removal. The prognosis for all brain tumors is not necessarily poor. Treatment is individualized and can have varying prognostic outcomes. Benign tumors are not metastatic, meaning they do not grow rapidly or spread into surrounding tissue, but they can still be considered life-threatening.

Which statement is true about malignant tumors?

They gain access to the blood and lymphatic channels. Explanation: By gaining access to blood and lymphatic channels, a tumor can metastasize to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rates of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.

For which reasons are nonpharmacologic pain management techniques used? Select all that apply.

They help decrease the sensation of pain. They help decrease the distress a client experiences as a result of pain. They allow clients to match the technique to their own individual and cultural preferences. Explanation: Nonpharmacologic pain management techniques are usually used in conjunction with medications and help to decrease the sensation of pain and the distress the client experiences as a result of pain. Nonpharmacologic methods are used to complement, not replace, pharmacologic methods in cases of severe pain. Many clients find that the use of nonpharmacologic methods helps them cope better with their pain and feel they have greater control over the pain. Nonpharmacologic methods do not have any relation to a client's risk of becoming addicted to pain medications. A variety of techniques allows clients to match the technique to their own individual and cultural preferences.

The nurse is describing the necessity of recovery periods between treatment cycles to a client receiving chemotherapy. How should the nurse best explain the need?

Time is needed to replace many of the healthy body cells killed by chemotherapy. Explanation: Cyclic administration involves taking the drugs for a specific period, with a recovery period following each treatment cycle. The recovery period allows time for the client to produce new, healthy cells to replace the normal rapidly dividing cells that have been affected by the drugs. Recovery time is unrelated to energy reserves, fluid balance, and nutrition. Recovery time does not necessarily correspond to the schedule for radiation therapy; not every client who receives chemotherapy will receive radiation therapy.

An oncologic client is scheduled to begin antiangiogenesis therapy. What is the goal of this type of treatment?

To limit the size of the tumor by limiting its ability to recruit blood vessels Explanation: Antiangiogenesis therapy is designed to inhibit the growth of new blood vessels, thus limiting the availability of blood to the growing tumor, resulting in decreased oxygen delivery and decreased ATP synthesis. There are no genetic effects on the tumor promoters or genetics.

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?

Tumor pressure against normal tissues Explanation: Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?

Turning the client from side to side, using the logroll technique Explanation: To avoid twisting the spine or hips when turning a client onto the side, the nurse should use the logroll technique. (Twisting after a laminectomy could injure the spine.) After surgery, the nurse shouldn't put anything under the client's knees or place the client in semi-Fowler's position because these actions increase the risk of deep vein thrombosis. Typically, the client is allowed out of bed by the first or second day after a laminectomy.

Select the statement that best describes stem cells.

Undifferentiated cells of continuously dividing tissues that have the capacity to generate multiple cell types Explanation: Stem cells are undifferentiated cells of continuously dividing tissues that have the capacity to generate multiple cell types. Labile cells, such as the epithelial cells of the skin and gastrointestinal tract, are those that continue to regenerate throughout life. Stable cells, such as those in the liver, are those that normally do not divide but are capable of regeneration when confronted with an appropriate stimulus. Permanent or fixed cells are those that are unable to regenerate

The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic?

Usually progressive and slow Explanation: A benign neoplasm's rate of growth is usually progressive and slow. Malignant neoplasms have undifferentiated cells, grow by invasion, and gain access to the blood and lymph channels to metastasize to other areas of the body.

Which of the following would be consistent with a benign neoplasm?

Usually progressive and slow Explanation: A benign neoplasm's rate of growth is usually progressive and slow. Malignant neoplasms have undifferentiated cells, grow by invasion, and gain access to the blood and lymph channels to metastasize to other areas of the body.

The nurse is caring for a client who is receiving a combination of antineoplastic agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse's best response?

Validate the client's sense of impending loss and offer guidance for getting a wig. Explanation: The nurse should empathically validate the client's sense of loss. Offering to assist with a practical solution is also useful. The facts that the hair loss is temporary and happens to other people are unlikely to provide any real consolation. Similarly, telling the client to see it as a positive is likely to be interpreted as simplistic.

Which drug would be classified as a mitotic inhibitor?

Vincristine Explanation: Vincristine is classified as a mitotic inhibitor. Fluorouracil and methotrexate are classified as antimetabolites. Chlorambucil is classified as an alkylating agent.

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to:

drink a lot of water. Explanation: An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug.

A 90-year-old home care client's son has been designated to make decisions regarding the client's medical care when the client is no longer able to do so. As the client nears the end of life, the son is consulted on an ever-increasing basis. What legal instrument activates the son's decision-making designation?

durable power of attorney for health care Explanation: A durable power of attorney (DPOA) for health care or healthcare proxy is the person the client designates to make medical decisions on the client's behalf when the client no longer can do so. It allows competent clients to identify exactly what life-sustaining measures they want to be implemented, avoided, or withdrawn and offers reassurance that others will carry out their wishes. Power of attorney is a legal term used in a different context. A living will is a written or printed statement describing a person's wishes concerning medical care and life-sustaining treatments that are wanted or unwanted in the event that a person is unable to personally make those decisions. Although a living will describes a person's wishes, it does not designate decision-making power to another person in the same was as a DPOA. Designated signer is not a term used in healthcare.

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice?

eats red meat such as steaks or hamburgers every day Explanation: Dietary substances such as nitrate-containing and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. Alcohol consumption recommendations include drink no more than one drink per day for women or two per day for men.

Select the option that best identifies how adult cancers differ in origin from childhood cancers. Adult cancers originate from:

epithelial cells. Explanation: Adult cancers are typically of epithelial cell origin, while childhood cancers involve the hematopoietic system, nervous system, soft tissues, bone, and kidneys. Childhood cancers have a more primitive (embryonic) appearance.

The nurse administered an analgesic to a client who was reporting pain. The medication is ordered as needed every 3 hours. Forty minutes later the client states he has had little relief. The nurse does all of the following:

evaluates the pain level using the established pain scale assesses respirations, pulse, and blood pressure consults with the healthcare provider about the client's report Explanation: The dose of the pain medication is ineffective in relieving the client's pain. The nurse evaluates client response using the same pain scale and vital signs. The nurse may need to consult with the healthcare provider and inform of the ineffectiveness of the medication. The nurse places the client in a position of comfort to enhance effectiveness of the medication now, not later. The nurse's statement delays appropriate treatment for the client.

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes?

exposure to carcinogens Explanation: When normal growth-regulating genes (protooncogenes) are exposed to carcinogens, they may undergo genetic alteration and become oncogenes. This can stimulate continuous cell growth, allowing abnormal, disordered, and unregulated cell replication. Exposure to the other factors does not result in this alteration.

A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends

increasing the amount of bran and fresh fruits and vegetables Explanation: Constipation is a common problem with the use of opioid medications, such as methadone. Activities to prevent constipation include increasing bran and fresh fruits and vegetables in the diet. The client should ingest 8 to 10 glasses of fluids per day. Milk of magnesia may be used if no bowel movement is produced in 3 days. Milk of magnesia is not to be used daily. A glycerin suppository, not bisacodyl, may be used to make the bowel movement less painful.

A client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply.

instructs the client to discontinue calcium asks about nausea and vomiting teaches the client to report abdominal or bone pain Explanation: The client with cancer is at risk for hypercalcemia from bone breakdown. The client should not take an over-the-counter calcium supplement that would increase blood levels of calcium. Signs and symptoms of hypercalcemia include nausea and vomiting. The client may also report abdominal or bone pain with cancer. The client should increase fluid intake to 2 to 4 L per day. Intake would have to be adjusted based on the client's other medical conditions. GERD would not negate an increase in fluid intake. The client most likely would have constipation with hypercalcemia, not diarrhea.

The nurse is educating a client who is undergoing gamma knife radiosurgery for a brain metastasis. What advantage to this procedure should the nurse share when comparing it to other conventional treatments?

less cognitive dysfunction Explanation: Gamma knife radiosurgery allows the application of focused radiation for limited brain metastasis and is associated with fewer long-term complications, such as cognitive dysfunction, compared to whole-brain radiation. Seizure activity, migraine headaches, and vomiting all can be related to the primary tumor in the brain

A decrease in circulating white blood cells (WBC) is referred to as which of the following?

leukopenia. Explanation: 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.

Which of the following nursing interventions contributes to achieving a client's pain relief?

llaborate with the client about his or her goal for a level of pain relief. Explanation: The nurse should collaborate with each client about his or her goal for a level of pain relief; this helps implement interventions for achieving the goal. The client's description of pain or need for pain relief should never doubted or minimized. The client need not refrain from self-administering analgesics; providing a client with equipment to self-administer analgesics promotes a more consistent level of pain relief. The nurse should also inform the client of available pain management techniques and incorporate any preferences or objections to interventions for pain management that the client may have when establishing a plan of care; using all forms of available pain management techniques is not necessary

Bone density testing in clients with post-polio syndrome has demonstrated

low bone mass and osteoporosis. Explanation: Bone density testing in clients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with clients and their families.

Which would the nurse identify as an antineoplastic antibiotic?

mitomycin Explanation: Mitomycin is an example of an antineoplastic antibiotic. Teniposide, vinblastine, and docetaxel are examples of mitotic inhibitors

Cancerous transformation of a cell requires the activation of:

multiple mutations. Explanation: The acquisition of a single gene mutation is not sufficient to transform normal cells into cancer cells. Cancerous transformation seems to require the activation of many independently mutated cells. Tumor suppressor genes normally inhibit proliferation; and when inactivated, unregulated cell growth begins. Apoptosis is suppressed (rather than activated), so that cancer cells continue to cycle and proliferate instead of dying on schedule.

When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply.

muscle weakness cramps and spasms in the legs loss of balance and coordination Explanation: Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.

A client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. The client is without breakthrough pain at this point in time. How would this client's pain be classified?

neuropathic and chronic Explanation: When classified according to its source, pain can be categorized as nociceptive or neuropathic. When classified according to its onset, intensity, and duration, pain can be categorized as either acute or chronic. Because the client is without breakthrough pain at this time, he has no acute pain. Nociceptive pain is transmitted from a point of cellular injury to the brain. This is not the type of pain related to long-term diabetes mellitus. Neuropathic pain sustained by injury or dysfunction of the peripheral or central nervous systems. This type of pain is related to long-term diabetes mellitus. Acute pain is pain or discomfort of short duration: from a few seconds to less than 6 months. This is not the type of pain related to long-term diabetes mellitus.

A client is on a second round of radiation therapy for an inoperable tumor, and asks the nurse for medication to help with pain. The nurse suspects that the client's pain is the result of nerve damage from the radiation. Which type of pain is the client likely experiencing?

neuropathic pain Explanation: Neuropathic pain can affect cancer patients due to nerve damage from chemotherapy or radiation therapy. Somatic pain is caused by damage or disorders that affect bones, joints, muscles, skin, or other structures. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is pain felt in the body in a location that is different from the actual source of the pain

A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for:

neurotoxicity. Explanation: Neurotoxicity is a major problem associated with paclitaxel therapy, and close monitoring is needed. Neurotoxicity generally begins 2 to 3 days after the infusion. Cardiotoxicity is observed in less than 1% of patients. The drug is not known to cause constipation or asthma.

According to the TNM classification system, T0 means there is

no evidence of primary tumor. Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.

A client had a positive Pap smear. The surgeon diagnosed "cancer in situ of the cervix." The client asks, "What does this mean?" From the following statements, which is most appropriate in response to this question? The tumor has

not crossed the basement membrane, so it can be surgically removed with little chance of growing back. Explanation: Cancer in situ is a localized preinvasive lesion. As an example, with breast ductal carcinoma in situ, the cells have not crossed the basement membrane. Depending on its location, an in situ lesion usually can be removed surgically or treated so that the chances of recurrence are small. For example, cancer in situ of the cervix is essentially 100% curable.

A type of comprehensive care for clients whose disease is not responsive to cure is

palliative care. Explanation: Palliative care is a type of comprehensive care for clients whose disease is not responsive to cure. Terminal illness is a progressive, irreversible illness that despite cure-focused medical treatment will result in the client's death. Euthanasia means the intentional killing by act or omission of a dependent human being for his or her alleged benefit. Interdisciplinary collaboration is communication and cooperation among members of diverse health care disciplines jointly to plan, implement, and evaluate care.

The nurse sees an order for a lidocaine 5% patch. What use is approved for by the US Food and Drug Administration for this patch?

postherpetic neuralgia Explanation: A lidocaine 5% patch has been shown to be effective in postherpetic neuralgia. Lidocaine 5% patch has not been approved for epidural anesthesia, general anesthesia, or diabetic neuropathy.

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching?

prophylactic Explanation: Also called preventive surgery, prophylactic surgery may be done when there is a family history or genetic predisposition, ability to detect cancer at an early stage, and client acceptance of the postoperative outcome. Local excision is done when an existing tumor is removed along with a small margin of healthy tissue. Palliative surgery relieves symptoms. Cryoablation uses cold to destroy cancerous cells.

The nurse is caring for a client whose current antineoplastic regimen includes bicalutamide. The nurse should anticipate what additional aspect of this client's cancer treatment?

prostatectomy Explanation: Bicalutamide is administered in combination with a luteinizing hormone for the treatment of advanced prostate cancer. This medication would not be effective for treating bowel, thyroid or breast cancer because it is a hormone modulator and works only on androgen-receptor sites.

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to

reduce cerebral edema. Explanation: Corticosteroids may be used before and after treatment to reduce cerebral edema and to promote a smoother, more rapid recovery. Corticosteroids do not prevent extension of the tumor or facilitate regeneration of neurons. Stereotactic procedures identify the precise location of the tumor.

The goal of traditional antineoplastic drug therapy is to

reduce the size of abnormal cell mass for immune system destruction

A recent nursing graduate is receiving special training to become certified in handling and administering chemotherapy drugs. This special training is necessary because of what nursing diagnosis among clients receiving chemotherapy?

risk for injury related to chemotherapy Explanation: Because of the toxicity of chemotherapeutic agents, nurses who administer intravenous cytotoxic chemotherapy receive special training and are certified in handling and administering the chemotherapy drugs safely and accurately. Incorrect administration creates a serious risk for injury. Pain, contamination, and impaired health maintenance are not directly associated with incorrect administration.

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with

seizure. Explanation: A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium concentrations lower than 120 mEq/L.

When educating a client who has tested positive for human T-cell leukemia virus-1 (HTLV-1), what mode(s) of transmission should the nurse discuss to prevent the spread? Select all that apply.

sexual intercourse blood by sharing needles infants through breast milk Explanation: Human T-cell leukemia virus-1 (HTLV-1) is the only known retrovirus to cause cancer in humans. Similar to HIV, HTLV-1 is attracted to CD4+ T cells, and this subset of T cells is therefore the major target for cancerous transformation. The virus requires transmission of infected T cells through sexual intercourse, infected blood, or breast milk. Kissing a person on the forehead will not spread this virus, assuming all skin is intact.

A 2-year-old child has been diagnosed with neuroblastoma. The tumor is extremely large. Parents ask how this cancer could be so extensive, yet the child has not displayed many symptoms until this past week. Nurses explain that early diagnosis of childhood cancers is often difficult because the signs and symptoms are:

similar to those of other childhood diseases. Explanation: Early diagnosis is missed in childhood cancers because the signs and symptoms are similar to those of other childhood diseases. Multiple chromosomal mutations can cause some of the early childhood cancers, with signs and symptoms similar to other childhood diseases. Signs and symptoms are present even in the early stages of cancer. Childhood growth delays (rather than developmental delays) are associated with cancers and other diseases.

The community health nurse is planning care for a client who will be prescribed an oral chemotherapy drug for the next several months while recovering at home. What health education topic should the nurse emphasize?

techniques for safely handling the drug Explanation: All cytotoxic drugs are hazardous substances and require special handling and disposal, per safety guidelines, in the home. It is not possible for the client to independently monitor liver status in the home. Herbal substitutes for chemotherapy drugs do not exist, and doses are not adjusted based on short-term symptoms.

A cancer client has been prescribed 5-fluorouracil, an antimetabolite chemotherapy agent. This medication stops normal development and division by interrupting the S phase of the cell cycle. When teaching this client, the nurse explains that during the S phase of the cell cycle:

the synthesis of DNA occurs, causing two separate sets of chromosomes to develop. Explanation: During the S phase, DNA synthesis occurs, causing two separate sets of chromosomes to develop. Antimetabolites can cause abnormal timing of DNA synthesis. Because of their S-phase specificity, the antimetabolites are more effective when given as a prolonged infusion.

An oncology nurse is caring for a client with newly diagnosed B-cell lymphoma. Extensive blood work has been drawn and sent to the lab. Results reveal an elevated antiapoptotic protein BCL-2 level. The client/family asks, "What does this mean?" The health care provider bases his or her response on the fact that:

this means the cancer cells have found a way to survive and grow even with damaged DNA. Explanation: Alterations in apoptotic and antiapoptotic pathways have been found in many cancers. One example is the high levels of the antiapoptotic protein BCL-2 that occur secondary to a chromosomal translocation in certain B-cell lymphomas. The mitochondrial membrane is a key regulator of the balance between cell death and survival. Proteins in the BCL-2 family reside in the inner mitochondrial membrane and are either proapoptotic or antiapoptotic. Since apoptosis is considered a normal cellular response to DNA damage, loss of normal apoptotic pathways may contribute to cancer by enabling DNA-damaged cells to survive.

A nurse is providing education to a client who is preparing to begin chemotherapy for the treatment of cancer. What action should the nurse encourage the client to implement to minimize the effects of chemotherapy-triggered mucositis?

thoroughly rinse the mouth often, especially before and after meals Explanation: A client who is experiencing mucositis should rinse the mouth several times daily, especially before meals (to decrease unpleasant taste and increase appetite) and after meals (to remove food particles that promote growth of microorganisms). Fluid intake should be increased, and commercial mouthwashes should be avoided. Analgesia therapy is usually topical, rather than oral.

When taking a client history, the nurse notes that the client is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding?

Ginkgo Explanation: Ginkgo, when taken with acetaminophen, enhances the risk of bleeding. Echinacea, willow, and kava, when taken with acetaminophen, increase the potential for hepatotoxicity and nephrotoxicity

When drafting a nursing care plan for a patient in pain, it is important for the nurse to determine if the pain is acute or chronic. Choose the best example of chronic pain.

Intervertebral disk herniation Explanation: Chronic pain is found with degeneration or traumatic conditions and can sometimes be the cause of the patient's primary disorder. The other three choices refer to acute pain. Migraines could be chronic pain but are not the best example here.

A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain?

Administer analgesics around the clock. Explanation: Because assessing pain medication needs in a client with end-stage dementia is difficult, analgesics should be administered around the clock. Clients at this stage of dementia typically can't request oral pain medications when needed. They're also unable to use patient-controlled analgesia devices. Transdermal patches are used to manage chronic pain; not postoperative pain

An oncology nurse is caring for a client who relates that certain tastes have changed. The client states that "meat tastes bad." What nursing intervention can be used to increase protein intake for a client with taste changes?

Encourage eating cheese, eggs, and legumes Explanation: The nurse encourages the clients with taste changes to eat cheese, eggs, and legumes. Encouraging the client to take in the maximum amount of fluids does not increase protein intake. The nurse advises the client to drink protein beverages. Sucking on hard candies during treatment does not increase protein intake.

The nurse is administering a narcotic analgesic for the control of a newly postoperative client's pain. What medication will the nurse administer to this client?

Fentanyl (Duragesic) Explanation: Opioid and opiate analgesics such as morphine and fentanyl (Duragesic) are controlled substances referred to as narcotics. The other medications are not opioid analgesics and should not be given for a newly postoperative client.

In which phase of the cell cycle does cell division occur?

Mitosis Explanation: Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase.

Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission?

A child quickly removing a hand when touching a hot object Explanation: Transduction, the first process involved in nociception, refers to the processes by which a noxious stimulus, such as a burn, releases of a number of excitatory compounds, which move pain along the pain pathway. Transmission, the second process involved in nociception, is responsible for a rapid reflex withdrawal from painful stimulus. The third process involved in nociception is perception. Imagery is based on the belief that the brain processes can strongly influence pain perception. A dual-mechanism analgesic agent, such as tramadol, involves many different neurochemicals as in the process of modulation.

Which of the following is a disadvantage of using the transdermal route of opioid administration?

A delay in effect until the dermal layer is saturated Explanation: A disadvantage of using the transdermal route of administration is that there is a delay in effect when the dermal layer is saturated. Advantages include a consistent opioid serum level, slightly less constipation than with oral opioids, and less cost as compared to the parenteral route.

The nurse understands that which statement is true about tolerance and addiction?

Although clients may need increasing levels of opioids, they are not addicted. Explanation: Physical tolerance usually occurs in the absence of addiction. Tolerance to opioids is common. Addiction to opioids is rare and should never be the primary concern for a client in pain.

A client with appendicitis has had an appendectomy. After surgery, what type of pain does the nurse anticipate the client will have?

Acute pain Explanation: Acute pain is a discomfort that has a short duration (from a few seconds to less than 6 months). It is associated with tissue trauma, including surgery, or some other recent identifiable etiology. The characteristics of chronic pain, discomfort that lasts longer than 6 months, are almost totally opposite from those of acute pain. An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Referred pain is a term used to describe discomfort that is perceived in a general area of the body, but not in the exact site where an organ is anatomically located.

Which oncologic emergency involves the accumulation of fluid in the pericardial space?

Cardiac tamponade Explanation: Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis that results in thrombosis and bleeding. SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

Carbamazepine (Tegretol) is an example of which medication classification used in analgesia?

Anticonvulsant Explanation: Tegretol is an anticonvulsant.

A client who fell at home is hospitalized for a hip fracture. The client is in Buck's traction, anticipating surgery, and reports pain as "2" on a pain intensity scale of 0 to 10. The client also exhibits moderate anxiety and moves restlessly in the bed. The best nursing intervention to address the client's anxiety is to

Assess the reason for the client's anxiety. Explanation: Following the steps of the nursing process, the nurse needs to assess the reason for the client's anxiety. The client could be anxious about impending surgery, an unattended pet, a sick family member, etc. Then, the nurse intervenes appropriately by obtaining the assistance the client may need or administering anti-anxiety medication. The question is asking about treatment for anxiety. Pain medication should not be administered for anxiety. The nurse will not assist the client to a chair, because the client is on bedrest and in Buck's traction.

A preventative approach to pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) means that the medication is given:

Before pain is experienced. Explanation: NSAIDs are most effective for preventive pain management when administered on a fixed-schedule (i.e., every 3-4 hours) to prevent the pain experience. When combined with an opioid, the medication regimen is highly effective in managing moderate to severe pain.

Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure?

Blood studies Explanation: Before the HSCT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before an HSCT procedure, the nurse need not evaluate client's family, drug, or allergy history.

The nurse is caring for a client in the hospital who has been taking an analgesic for pain related to a chronic illness and has developed a tolerance to the medication. What is the most appropriate action by the nurse?

Consult with the prescriber regarding the need for an increased dose of the drug and not to reduce the frequency of administration. Explanation: The most appropriate action by the nurse would be to consult with the physician regarding the need for an increased dose of the drug and not to reduce its frequency of administration. As a rule of thumb, an ineffective dose should be increased by 25% to 50%. Informing the client that he will not be able to receive more medication is not acting as a client advocate nor acting in the best interest of the client. Suggesting a psychiatrist consultation would not be an appropriate action because the client has a chronic illness that requires medication. Taking a non-narcotic analgesic would not provide the client with the pain relief that he has.

A client is being taught to self-administer a narcotic analgesic by means of an intravenous PCA pump system. Which of the following would help prevent accidental overdosage?

Programming the dosage and time interval into the device Explanation: When the client is being taught to self-administer a narcotic analgesic, the dosage and time interval between doses are programmed into the PCA intravenous pump system to prevent accidental overdosage. The frequency or dosage of the narcotic analgesic need not be reduced. Although a schedule chart is useful to the client, it does not effectively prevent accidental overdosage.

A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be:

Prolonged in duration. Explanation: A major distinguishing characteristic between acute and chronic pain is its duration. Chronic is always prolonged.

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?

Stage 3 pressure ulcer on the left heel Explanation: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.

Regarding tolerance and addiction, the nurse understands that

although clients may need increasing levels of opioids, they are not addicted. Explanation: Physical tolerance usually occurs in the absence of addiction. Tolerance to opioids is common. Addiction to opioids is rare and should never be the primary concern for a client in pain.

The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply.

"How long have you experienced this pain?" "Please point to where you are experiencing pain." "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." "What aggravates your chest pain?" Explanation: The nurse needs to assess pain as to intensity, timing, location, and aggravating factors. Assessing frequency is important, but the statement "You've never had this pain before, have you" is leading and nontherapeutic.

When caring for a patient who is deaf, which of the following should be used to elicit information regarding the patient's level of pain?

An outside interpreter should be used. Explanation: For people who are deaf of hard of hearing, outside interpreters (i.e., not family members) should be used. For people with disabilities that result in communication impairment, computer-generated speech may be useful. For people who are blind and who know how to read Braille, pain assessment instruments can be obtained in Braille. The patient is deaf, so verbally asking to rate the pain on a scale would be inappropriate.

Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer?

Biopsy of the axillary lymph nodes Explanation: The transport of tumor cells through the lymphatic circulation is the most common mechanism of metastasis. Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates with lymphatic circulation. Breast tumors frequently metastasize in this manner through axillary, clavicular, and thoracic lymph channels.

Prostaglandins are chemical substances with what property?

Increase the sensitivity of pain receptors Explanation: Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin. Endorphins and enkephalins reduce or inhibit transmission or perception of pain. Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin

A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing?

Neuropathic pain Explanation: An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Chronic pain sufferers may have periods of acute pain, which is referred to as breakthrough pain. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is a term used to describe discomfort that is perceived in a general area of the body but not in the exact site where an organ is anatomically located.

A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis?

Red, open sores on the oral mucosa Explanation: The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

A client has been given a patient-controlled analgesia (PCA) device to control postoperative pain. The client expresses concern about administering too much of the analgesic and accidentally overdosing. What topic should the nurse teach the client about?

the limits on dose and frequency that are programmed into the PCA Explanation: Patient-controlled analgesia (PCA) devices allow clients to self-administer their own narcotic analgesic using an intravenous pump system and pressing a handheld button. The dose and time intervals between doses are programmed into the device to prevent accidental overdose. Dosing may or may not be more than twice per hour. Naloxone treats overdoses, but this will not likely alleviate the client's concerns about overdosing in the first place. The client may benefit from non-pharmacologic pain measures, but should not be encouraged to minimize the use of the PCA or to endure pain.

The nurse understands the definition of pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Which of the following comments by a client confirm the client's understanding of the fundamental concepts of pain? Select all that apply.

"I am tired of living with this nagging pain; I'm not sure how much longer I can go on." "I would love to go to church, but my back pain is too uncomfortable to make it through the service." "I used to walk every day for exercise; pain in my knee made me stop walking." Explanation: A fundamental concept of pain is that pain is a complex phenomenon that can affect a person's psychosocial, emotional, and physical functioning. Helplessness is an emotional response to pain. Inability to continue normal activities, such as going to church, is a psychosocial consequence of pain. Inability to perform normal exercise because of pain is a physical restriction related to pain. Pain is highly personal and subjective. The client's report is the most reliable indicator of pain. The client works with the nurse and doctor to establish a pain management regimen.

The client is prescribed 2 mg of intravenous morphine every 2 hours as needed for pain. The nurse administers the medication. Thirty minutes later, the client reports the pain level remains at a "6" on a pain intensity scale of 0 to 10. The nurse first

Assesses the client's mental status and vital signs Explanation: The nurse is to reassess the client after administration of a medication for pain. Reassessment includes a pain rating scale, mental status, and vital signs. If the reassessment of the client demonstrates the client is alert, has satisfactory vital signs, and reports unrelieved pain, the nurse then consults with the physician. The listed statement of the nurse is nontherapeutic. It is not appropriate to teach the client about guided imagery or distraction when the client has pain. It should be done prior to pain onset.

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise?

Avoid spicy and fatty foods. Explanation: The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.

The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for?

Bradypnea Explanation: Most patients experience sedation at the beginning of opioid therapy and whenever the opioid dose is increased significantly. If left untreated, excessive sedation can progress to clinically significant respiratory depression (bradypnea, or reduced breathing rate).

A patient comes into the clinic frequently with complaints of pain. What would the nurse recognize as chronic benign pain in a patient?

Low back pain Explanation: Acute pain differs from chronic pain primarily in its duration. For example, tissue damage as a result of surgery, trauma, or burns produces acute pain, which is expected to have a relatively short duration and resolve with normal healing. Chronic pain is subcategorized as being of cancer or noncancer origin and can be time limited (e.g., may resolve within months) or persist throughout the course of a person's life. Examples of noncancer pain include peripheral neuropathy from diabetes, back or neck pain after injury, and osteoarthritis pain from joint degeneration.

A nurse is caring for client receiving fentanyl through an epidural catheter. What medication should be readily available for the client who is experiencing respiratory depression?

naloxone Explanation: Opioid antagonist agents such as naloxone must be available for IV use if respiratory depression occurs. Diphenhydramine is used for opioid-induced pruritus. Aspirin and ibuprofen would not be used for respiratory depression.

The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe?

Gabapentin Explanation: The anticonvulsant gabapentin is a first-line analgesic agent for neuropathic pain. Tramadol is designated as a second-line analgesic agent for the treatment of neuropathic pain. Ketamine is used as a third-line analgesic agent for refractory acute pain. Hydromorphone is a first-line opioid not used as an analgesic agent for neuropathic pain.

The nurse is caring for a client admitted to the medical-surgical unit after an injury. The client states "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the client's care, what variables should the nurse consider? Select all that apply.

How the presence of pain affects clients and families Resources that can assist the client with pain management The advantages and disadvantages of available pain relief strategies Explanation: Nurses should understand the effects of chronic pain on clients and families and should be knowledgeable about pain relief strategies and appropriate resources to assist effectively with pain management. There is no evidence of cognitive deficits in this client and the difference between acute and intermittent pain has no immediate bearing on this client's care.

Which condition is a heightened response that occurs after exposure to a noxious stimulus?

Sensitization Explanation: Sensitization is a heightened response that occurs after exposure to a noxious stimulus. Pain tolerance is the maximum intensity or duration of pain that a person is willing to endure. Pain threshold is the point at which a stimulus is perceived as painful. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued.

Which of the following is a disadvantage to using the IV route of administration for analgesics?

Short duration Explanation: Disadvantages of using the IV route for analgesic administration include short duration, the occurrence of possible respiratory depression, and that careful dosage calculations are needed. Intramuscular analgesics have a slower entry into the bloodstream.

An adult with severe cognitive impairment has had a surgical procedure, and the nurse is having a difficult time assessing the level of pain the client is having postoperatively. What method can the nurse use to obtain data about the client's pain?

Use behavioral comparison of the client's current and previous behavior patterns. Explanation: Cognitively impaired older adults may be unable to report pain; comparison of current behavior with previous behavior patterns and reports from caregivers can help in assessing pain in these clients. Pain may manifest as agitation; aggression; withdrawal; or changes in behavior, positioning, or sleep patterns. The other methods would not be appropriate for a cognitively impaired client. Asking the client loudly will not increase his understanding.

The nurse is caring for a client with kidney stones who is complaining of severe pain. What type of pain does the nurse understand this client is experiencing?

Visceral Pain Explanation: Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Somatic pain is caused by mechanical, chemical, thermal, or electrical injuries or disorders affecting bones, joints, muscles, skin, or other structures composed of connective tissue. Neuropathic pain is pain that is processed abnormally by the nervous system. Chronic pain is discomfort that lasts longer than 6 months and is almost totally opposite from those of acute pain.

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?

Administering the analgesics every three hours Explanation: Scheduling the administration of analgesics every three hours, rather than on an as-needed basis, often affords a uniform level of pain relief. Administering the analgesics intravenously or with increased dosage is not advisable unless prescribed by the physician.

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?

Administering the analgesics on a regular basis Explanation: Routine scheduling of the administration of analgesics, rather than on an as-needed basis, often affords a uniform level of pain relief. Administering the analgesics intravenously or with increased dosage is not advisable unless prescribed by the physician.

The physician has ordered a mu opioid analgesic for a patient with pain. What drug does the nurse anticipate administering?

Fentanyl Explanation: Opioid analgesic agents are divided into two major groups: (1) mu agonist opioids (also called morphine-like drugs) and (2) agonist-antagonist opioids. The mu agonist opioids comprise the larger of the two groups and include morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and methadone, among others. The agonist-antagonist opioids include buprenorphine (Buprenex, Butrans), nalbuphine (Nubain), and butorphanol (Stadol)

An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client?

Follow a bowel regimen. Explanation: The nurse should ensure that a bowel regimen to prevent constipation is started when any older adult is treated with opioids. A high-fiber diet along with increased fluids should be encouraged. The client should not reduce fiber intake because this increases the risk for constipation. The client need not exercise regularly or avoid harsh sunlight because these have no effects on the drug therapy.

The nurse informs the patient that a preventive approach for pain relief will be used, involving nonsteroidal anti-inflammatory drugs. What will this mean for the patient?

The pain medication will be administered before the pain is experienced. Explanation: Two basic principles of providing effective pain management are preventing pain and maintaining a pain intensity that allows the patient to accomplish functional or quality-of-life goals with relative ease (Pasero, Quinn et al., 2011). Accomplishment of these goals may require the mainstay analgesic agent to be administered on a scheduled around-the-clock (ATC) basis, rather than PRN (as needed) to maintain stable analgesic blood levels.

When using transdermal Fentanyl, the nurse and patient should be aware of which sign or symptom of Fentanyl overdose?

confusion Explanation: Patients should be informed about signs and symptoms of fentanyl overdose such as shallow or difficulty breathing, extreme sleepiness, confusion, sedation. Hyperalertness, hyperventilation, and insomnia would not occur.

The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is

ginseng Explanation: Ginseng may inhibit the analgesic effects of an opioid, such as oxycodone. The other herbs listed (valerian, kava-kava, and chamomile) may increase central nervous system depression.

A client has been using nonnarcotic analgesics daily over an extended period. Which of the following effects should the nurse carefully monitor for in this client?

Gastrointestinal bleeding Explanation: Some nonnarcotic analgesics when used daily over an extended period may cause undesirable side effects such as gastrointestinal bleeding and hemorrhagic disorders. Use of analgesics does not increase the risk for developing cardiac disorders, urinary tract infections, or hypothyroidism.

A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies

"What do you mean by the word sick?" Explanation: Nausea may occur with opioid use; however, before taking any other action, the nurse needs to clarify that this is what the client means by the word "sick."

Which of the following is a true statement with regards to the preventative approach to the use of analgesics?

Smaller doses of medication are needed. Explanation: Smaller doses of medication are needed with the preventative approach, because the pain does not escalate to a level of severe intensity. A preventative approach may result in the administration of less medication over a 24-hour period, helping prevent tolerance to analgesic agents and decreasing the severity of side effects. The preventative approach reduces the peaks and troughs in the serum level and provides more pain relief with fewer side effects.

A 19-year-old woman had a mandibular osteotomy (jaw surgery) performed early this morning and is being assessed by the nurse after being transferred from the PACU. The nurse has asked the patient about her pain, to which the patient has responded, "I'm not really having any pain, but I've got a dull ache all around my jaw that's really bad." How should the nurse best interpret this patient's statement?

The patient is experiencing pain but is describing it in different terms. Explanation: It is reasonable to conclude that this patient is experiencing pain but is using different terms to describe the sensation. It would be erroneous for the nurse to conclude that this patient is pain free and to reject interventions. This patient is not "misinterpreting" her sensation but is rather characterizing it in a different way from the nurse.

When completing a teaching plan for a client receiving patient-controlled analgesia (PCA), which component would be important for the nurse to stress?

The pump will deliver a preset amount of medication. Explanation: A client experiencing pain can administer small amounts of medication directly into the IV, subcutaneous, or epidural catheter by pressing a button. The pump then delivers a preset amount of medication. The client should not wait until the pain is severe to push the button. Even if the client pushes the button multiple times in rapid succession, no additional doses are released because of the preset lock-out time. Sedation can occur with the use of the PCA pump. Assessment of respiratory status remains a major nursing role.

A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing?

visceral Explanation: Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Visceral pain usually is diffuse, poorly localized, and accompanied by autonomic nervous system symptoms such as nausea, vomiting, pallor, hypotension, and sweating. Neuropathic pain is pain that is processed abnormally by the nervous system. Deeper somatic pain such as that caused by trauma produces localized sensations that are sharp, throbbing, and intense. Chronic pain has a duration longer than 6 month