Week 13: Cancer Types and Care
A client with a modified radical mastectomy is being discharged. The client has been very reluctant to discuss the surgery or her situation. The nurse making assignments should delegate the client's care to the: A. unlicensed assistive personnel (UAP) because the client is stable and being discharged. B. same nurse who has cared for her the past 3 days, for continuity of care. C. nurse in orientation who needs experience in discharge instructions. D. nurse with the most bed baths, because this client will not need a bath.
B. same nurse who has cared for her the past 3 days, for continuity of care. Continuity of care is crucial for this client to feel more comfortable about asking questions and discussing her care at home.A UAP does not have the educational preparation (registered nursing license) to provide discharge instructions.It is not appropriate to assign this client to a nurse in orientation or one who needs assistance; the priority need is continuity of care.
The nurse is conducting a health history for a client at risk for cancer. Which lifestyle factor is considered a risk for colorectal cancer? a diet low in vitamin C a high dietary intake of artificial sweeteners a high-fat, low-fiber diet multiple sex partners
a high-fat, low-fiber diet Explanation: A high-fat, low-fiber diet is a risk factor for colorectal cancer. A diet low in vitamin C, use of artificial sweeteners, and multiple sex partners are not considered risk factors for colorectal cancer.
A client diagnosed with terminal lung cancer expresses a desire to seek spiritual advice. Which intervention by the nurse bestprovides spiritual support for this client? a. Ask who the client's spiritual advisor is and make the contact. b. Ask if the client would like to talk to speak to the nurse. c. Contact the most available spiritual advisor such as clergy from another faith. d. Identify the name of the spiritual advisor from the client's admission history.
a. Ask who the client's spiritual advisor is and make the contact. Explanation: The nurse may contact the client's spiritual advisor if the client so desires. The nurse can listen to the client, but spiritual support is best from someone proficient in that field, such as a spiritual advisor. It would be appropriate for the nurse to contact the clergy of another faith, only if no other resources are available and if the client consents. The nurse should speak with the client and get the information firsthand, before researching the admission history.
Which factor places a client at greatest risk for skin cancer? a. Fair skin and history of chronic sun exposure b. Caucasian race and history of hypertension c. Dark skin and family history of skin cancer d. Dark skin and history of hypertension
a. Fair skin and history of chronic sun exposure Explanation: Caucasians who have fair skin and a high exposure to ultraviolet light are at increased risk for malignant neoplasms of the skin. The other risk factors include exposure to tar and arsenicals and family history. History of hypertension is a coronary artery disease risk factor. Clients with dark skin have increased melanin and are not as prone to skin cancer.
A woman with a history of a left radical mastectomy is being admitted for abdominal surgery. The woman has a swollen left arm. What should the nurse do to protect the client's swollen arm? a. Take the blood pressure only in the unaffected arm. b. Start an IV line in the affected arm. c. Encourage a dependent position of the affected arm. d. Allow blood draws in the affected arm.
a. Take the blood pressure only in the unaffected arm. Explanation: Lymphedema occurs frequently after radical mastectomy when lymph nodes are removed. Aplasia, or the absence of lymph nodes, prevents proper lymph drainage. The tissue swelling is caused by obstructed lymph flow in the extremity. The blood pressure is taken in the unaffected arm to avoid further accumulation of lymphedema. An IV line should not be started in the affected arm. The nurse would encourage the client to elevate the extremity above the level of the heart. Blood draws in the affected arm should not be allowed.
A client asks the nurse what PSA is. The nurse should reply that it stands for a. prostate-specific antigen, which is used to screen for prostate cancer. b. protein serum antigen, which is used to determine protein levels. c. pneumococcal strep antigen, which is a bacteria that causes pneumonia. d. Papanicolaou-specific antigen, which is used to screen for cervical cancer.
a. prostate-specific antigen, which is used to screen for prostate cancer. Explanation: PSA stands for prostate-specific antigen, which is used to screen for prostate cancer.
A 36-year-old female is scheduled to receive external radiation therapy and a cesium implant for cancer of the cervix and is asking about the effects of the radiation on sexual relations during and after the radiation therapy. The nurse should inform the client about which potential effect of radiation therapy on sexuality? a. "You will be able to have sexual intercourse while the implant is in place." b. "You will have vaginal dryness after treatment is completed." c. "You will experience vaginal relaxation after treatment is completed." d. "You will continue to have normal menstrual periods during treatment."
b. "You will have vaginal dryness after treatment is completed." Explanation: Radiation fields that include the ovaries usually result in premature menopause. Vaginal dryness will occur without estrogen replacement. There should be no sexual intercourse while the implant is in place. Cesium is a radioactive isotope used for therapeutic irradiation of cancerous tissue. There is no documentation to support vaginal relaxation after treatment. Because the client will have premature menopause, she will not have normal menstrual periods.
During a breast examination, which finding most strongly suggests that a client has breast cancer? a. Slight asymmetry of the breasts b. A fixed nodular mass with dimpling of the overlying skin c. Bloody discharge from the nipple d. Multiple firm, round, freely movable masses that change with the menstrual cycle
b. A fixed nodular mass with dimpling of the overlying skin Explanation: A fixed nodular mass with dimpling of the overlying skin is common during late stages of breast cancer. Many women have slightly asymmetrical breasts. Bloody nipple discharge is a sign of intraductal papilloma, a benign condition. Multiple firm, round, freely movable masses that change with the menstrual cycle indicate fibrocystic breasts, a benign condition.
What is an instruction the nurse can give to help people prevent lung cancer? a. Encourage cigarette smokers to have yearly chest radiographs. b. Instruct people about techniques for smoking cessation. c. Recommend that people have their houses and apartments d. checked for asbestos leakage. Encourage people to install central air cleaners in their homes.
b. Instruct people about techniques for smoking cessation. Explanation: Epidermoid cancer involving the larger bronchi is almost entirely associated with heavy cigarette smoking. The American and Canadian Cancer Societies report that smoking is responsible for more than 80% of lung cancers in men and women. The prevalence of lung cancer is related to the duration and intensity of the smoking, so nurses can best prevent lung cancer by persuading clients to stop smoking. Chest radiographs aid in detection of lung cancer; they do not prevent it. Exposure to asbestos has been implicated as a risk factor for lung cancer, but cigarette smoking is the major risk factor. There are no data to support the use of home air filters in the prevention of lung cancer.
A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (Canadian Cancer Society) guidelines, the nurse should recommend that the women a. perform breast self-examination annually. b. have a mammogram annually. c. have a hormonal receptor assay annually. d. have a physician conduct a clinical examination every 2 years.
b. have a mammogram annually. Explanation: The American Cancer Society (Canadian Cancer Society) guidelines state that women age 40 and older should have a mammogram annually and a clinical examination at least annually (not every 2 years). All women should perform breast self-examination monthly (not annually). The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.
Which action is most important when the nurse is planning pain management for a client after a lobectomy for lung cancer? a. repositioning the client immediately after administering pain medication b. reassessing the client after administering pain medication c. reassuring the client after administering pain medication d. readjusting the pain medication dosage as needed
b. reassessing the client after administering pain medication Explanation: It is essential for the nurse to evaluate the effects of pain medication after it has had time to act. Although other interventions may be appropriate, continual reassessment is most important to determine the effectiveness and need for additional intervention, if any. Repositioning could provide some comfort, but assessment of the client's pain level is essential. Reassuring the client is important, but it will be of no value unless the nurse evaluates the client's pain level. To readjust the pain dosage is appropriate only if titration is prescribed by the health care provider (HCP).
A client fears chemotherapy because of the side effects. What is the nurse's best response to the client's concerns? a. "Your health has been excellent. It's unlikely that you will experience serious side effects." b. "We'll give you medications to prevent the side effects, so you shouldn't be too concerned." c. "Each person responds differently to chemotherapy treatments. We'll monitor your responses closely." d. "You may choose not to take the chemotherapy, but you must understand that this will have an adverse effect on the course of your disease."
c. "Each person responds differently to chemotherapy treatments. We'll monitor your responses closely." Explanation: It is normal for the client who is beginning chemotherapy to be anxious and fearful about possible side effects. It is important that the nurse listen to the client's concerns, correct any misconceptions, and explain the supportive care that will be provided during the chemotherapy treatments. The client needs to understand that individuals do respond differently to the treatments, and the experience may be very different from those of other people. A previously excellent health record does not necessarily ensure that the client will not experience side effects. Medications may lessen but not prevent the side effects, so client concerns should not be dismissed. Telling the client that he or she will die if treatment is refused does nothing to allay fears and concerns.
A client is taking doxorubicin and is distressed about hair loss. What should the nurse do? a. Have the client wash and massage the scalp daily to stimulate hair growth. b. Explain that hair loss is temporary and will quickly grow back to its original appearance. c. Provide resources for a wig selection before hair loss begins. d. Recommend that the client limit social contacts until hair regrows.
c. Provide resources for a wig selection before hair loss begins. Explanation: Resources should be provided for acquiring a wig since it is easier to match hair style and color before hair loss begins. The client has expressed negative feelings of self-image with hair loss. Excessive shampooing and manipulation of hair will increase hair loss. Hair usually grows back in 3 to 4 weeks after the chemotherapy is finished; however, new hair may have a new color or texture. A wig, hairpiece, hat, scarf, or turban can be used to conceal hair loss. Social isolation should be avoided, and the client should be encouraged to socialize with others.
A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client? a. Wear sterile gloves when emptying bedpans or urinals. b. Allow the client to stand when urinating. c. Wear personal protective equipment when handling blood, body fluids, and feces. d. Provide a urinal or bedpan to decrease the likelihood of soiling linens.
c. Wear personal protective equipment when handling blood, body fluids, and feces. Explanation: Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Incontinence pads should be placed in the specified trash container, and providing a urinal or bedpan does not protect the nurse caring for the client. Male and female clients are encouraged to sit on the toilet to avoid splashing; the toilet should be flushed twice.
A nurse is assessing a client with metastatic lung cancer. The nurse should assess the client specifically for: a. diarrhea. b. constipation. c. hoarseness. d. weight gain.
c. hoarseness. Explanation: Hoarseness may indicate metastatic disease to the recurrent laryngeal nerve and is commonly noted with left upper lobe lung tumors. Diarrhea and constipation are not associated with lung cancer. Weight loss, not weight gain, can be a symptom of extensive disease. Remediation:
At a public health fair, a nurse teaches a group of women about breast cancer awareness. Possible signs of breast cancer include: a. fever. b.. breast changes during menstruation. c. nipple discharge and a breast nodule. d. fever and erythema of the breast.
c. nipple discharge and a breast nodule. Explanation: Nipple discharge, breast nodules, nipple retraction, and lymphadenopathy may be signs of breast cancer and should be reported. Mammary duct ectasia may cause fever, nipple discharge, breast nodules, erythema of the breast, and itching. Breast changes during menstruation are normal; for this reason, women should examine their breasts 4 to 7 days after menses ends, when the breasts are least congested. Fever and erythema of the breast may indicate a breast abscess.
A staff nurse on the oncology unit must teach the new unit assistant about infection-control practices. The nurse should explain that which measure is most important for preventing the spread of infection? a. double-bagging contaminated body fluids b. using sick time when not feeling well c. performing proper hand hygiene d. restricting fresh fruit and flowers from the client's room.
c. performing proper hand hygiene Explanation: Proper hand hygiene is the most important measure for preventing the spread of infection. Although fresh flowers and plants should be restricted in the clients' rooms, double-bagging is warranted for contaminated body fluids, and the staff should use sick time when feeling sick, these measures are not the most important for preventing the spread of infection.
A client is to have radiation therapy following a mastectomy. What should the nurse tell the client to expect as a normal local tissue response to radiation? a. atrophy of the skin. b. scattered pustule formation. c. redness of the surface tissue. d. sloughing of two layers of skin.
c. redness of the surface tissue. Explanation: The most common reaction of the skin to radiation therapy is redness of the surface tissues. Dryness, tanning, and capillary dilation are also common. Atrophy of the skin, pustules, and sloughing of two layers would not be expected and should be reported to the radiologist.
A client undergoing chemotherapy has a white blood cell count of 2,300/mm3 (2.3 X 109/L); hemoglobin of 9.8 g/dL (98 g/L); platelet count of 80,000/mm3 (80 X 109/L); and potassium of 3.8. Which finding should take priority? a. blood pressure 136/88 mm Hg b. emesis of 90 mL c. temperature 101° F (38.3° C). d. urine output 40 mL/h
c. temperature 101° F (38.3° C). Explanation: The client has a low white blood cell count from the chemotherapy and has a temperature. Signs and symptoms of infection may be diminished in a client receiving chemotherapy; therefore, the temperature elevation is significant. Early detection of the source of infection facilitates early intervention. Surveillance for bleeding is important with the low hemoglobin and platelet count; however, the high blood pressure does not indicate bleeding. Vomiting is a side effect of chemotherapy and should be treated. The urine output and potassium are within normal limits.
A nurse is conducting a cancer risk screening program. Which client is at greatest risk for skin cancer? a. 45-year-old health care worker b. 15-year-old high school student c. 30-year-old butcher d. 60-year-old mountain biker
d. 60-year-old mountain biker Explanation: Basal cell carcinoma occurs most commonly in sun-exposed areas of the body. The incidence of skin cancer is highest in older people who live in the mountains or spend outdoor leisure time at higher altitudes.
The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for? a. Actinic b. Asymmetry c. Arcus d. Assessment
d. Asymmetry Explanation: When following the ABCD method for assessing skin lesions, the A stands for "asymmetry," the B for "border irregularity," the C for "color variation," and the D for "diameter."
A client receiving chemotherapy is nauseated and has lost 15 pounds (6.8 kg) in one month. Which nutritional instruction would the nurse include in the plan of care? a. Encourage fluids with meals and snacks. b. Eat two high protein meals per day. c. Eat either hot or cold foods at meal times. d. Eat frequent but small meals.
d. Eat frequent but small meals. Explanation: Small quantities of food offered frequently allow the client to ingest food with the best chance of not having nausea. Eating two high protein meals per day may increase nausea. Fluids may distend the stomach and can cause nausea. Extremes in temperature can precipitate nausea.
The family of an older adult with terminal cancer asks about having hospice services. What should the nurse tell the family? Hospice care: a. focuses only on the needs of the client. b. can only be provided in the inpatient setting. c. is staffed exclusively by professional health care workers. d. focuses on supportive care for the client and family.
d. focuses on supportive care for the client and family. Explanation: Hospice care focuses on supportive care for the client and family. Care for the family may continue throughout the bereavement period. Hospice care involves care of the client at home as well as in an inpatient setting. Although professional care is provided in hospice, family members, volunteers, and unlicensed nursing personnel (UAP) also participate in the care of the client.
A client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the right arm, and the client's left arm and hand should be elevated as much as possible to prevent: a. carpal tunnel syndrome. b. peripheral neuropathy. c. contractures. d. lymphedema.
d. lymphedema. Explanation: Lymphedema is a common postoperative effect of modified radical mastectomy and lymph node dissection. Elevation of the left arm and hand will allow gravity to assist lymph drainage. Other preventive measures include exercises in which the arms are elevated. Peripheral neuropathy is not associated with postoperative complications, nor are contractures. Although muscle atrophy is a potential adverse effect if the client does not exercise the left arm, it would not be prevented by elevation.
A nurse is interviewing a client about their past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a. duodenal ulcers b. hemorrhoids c. weight gain d. polyps
d. polyps Explanation: Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.