2 NRS Exam 2: Cancer

A client has been hospitalized for removal of a cervical radiation implant used to treat cancer. The implant is removed, and the nurse provides home care instructions to the client. Which statement made by the client indicates understanding?

"Cream may be used to relieve dryness or itching." "Some vaginal bleeding is expected for 1 to 3 months." "Sexual intercourse may be resumed after 7 to 10 days." Some foul-smelling vaginal discharge is expected and is not a sign of an infection in this client. This will occur for some time after removal of a cervical radiation implant.

The nurse is reviewing the record of a client who was admitted to the hospital with a diagnosis of ovarian cancer. A client has received an unsealed radioactive isotope for treatment. Which instruction is essential for the nurse to provide the client?

"Flush the toilet at least 3 times after use." Bodily fluids contain the radioactive material, so others should be shielded from possible exposure. Clients should at best have a dedicated toilet for use during the first 2 weeks and should also flush 3 times after use. Some radioactivity will be in the saliva for about the first week, so during this time fruits with cores that will become contaminated should be avoided. Disposable eating utensils should also be used during this period of time. Contact with pregnant women, infants, and children is avoided for the first week and then a distance of 3 feet or more should be maintained and exposure should be limited to 1 hour per day.

The nurse has provided teaching for an adult client about screening for colon cancer. Which statement by the client indicates that education was effective?

"I should have an annual fecal occult blood test." Fecal occult blood testing for colorectal cancer should be done annually for both men and women. Less invasive diagnostic testing such as a fecal occult blood test will be performed first. Colonoscopy is done at age 50 and then every 10 years.

Tamoxifen is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement?

"This medication can be taken to prevent and treat clients with breast cancer." Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk.

The community nurse is conducting a health promotion program, and the topic of the discussion relates to the risk factors for gastric cancer. Which item, if identified as a risk factor by a client, is correct?

A high-fat diet Smoking Foods containing nitrates A diet of smoked, highly salted, and spiced foods

The clinic nurse has conducted a health screening clinic to identify clients who are at risk for cervical cancer. The nurse is reviewing the assessment findings in the records of the clients who attended the clinic. Which client is at lowest risk for developing this type of cancer?

A single white client Risk factors associated with cervical cancer include early, frequent intercourse with multiple sexual partners; multiparity; chronic cervicitis; and a history of genital herpes or human papilloma. Cervical cancer also occurs with higher frequency in African Americans.

During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease?

Abdominal distention Clinical manifestations of ovarian cancer include: - abdominal distention - urinary frequency and urgency - malnutrition - pain from pressure caused by the growing tumor - the effects of urinary or bowel obstruction: constipation, ascites with dyspnea, and ultimately general severe pain.

The nurse has provided discharge instructions to a client who underwent a right mastectomy with axillary lymph node dissection. What should be included?

After mastectomy with axillary lymph node dissection, the client is at risk for arm edema and infection. The client should be instructed regarding home care measures to prevent these complications. The client should be told to avoid activities such as carrying heavy objects or having blood pressure measurements taken on the affected arm. The client also should be instructed in the techniques to avoid trauma to the affected arm, such as using an electric razor to shave under the arms, using gloves when working in the garden, and using or wearing thick potholders when cooking.

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of Hodgkin's disease. Which assessment findings noted in the client's record are associated with this diagnosis?

Assessment of a client with Hodgkin's disease most often reveals enlarged, painless lymph nodes along with fever, malaise, and night sweats. Weight loss may be a feature in metastatic disease.

A cervical radiation implant is placed in a client who is undergoing treatment of cervical cancer. The nurse should initiate which activity prescription as the most appropriate for this client?

Bed rest The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is log-rolled.

The nurse is caring for a client with leukemia. In assessing the client for signs of leukemia, the nurse determines that what should be monitored?

Bone marrow biopsy Blood studies like CBC will not provide a definitive diagnosis of leukemia, only biopsy will

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?

Calcium level Tamoxifen may increase calcium, cholesterol, and triglyceride levels. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

The nurse is performing an admission assessment of a client with a possible right colon tumor. Which sign or symptom should the nurse anticipate the client may report?

Characteristic symptoms of right colon tumors include vague, dull, abdominal pain exacerbated by walking and dark red- or mahogany-colored blood mixed in the stool.

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that teaching has been successful when the client identifies what as an associated risk factor?

Colorectal cancer risk factors include: - age older than 50 years - a family history of the disease - colorectal polyps or ulcerative colitis - chronic inflammatory bowel disease - high-fat, low-fiber diet

Which are warning signs of head and neck cancer?

Difficulty swallowing Lump in the mouth, neck, or throat Persistent or unexplained oral bleeding Signs and symptoms of head and neck cancers include pain; lump in the mouth, throat, or neck; difficulty swallowing; color changes in the mouth or tongue to red, white, gray, dark brown, or black; oral lesion or sore that does not heal in 2 weeks; persistent or unexplained oral bleeding; numbness of the mouth, lips, or face; change in the fit of dentures; burning sensation when drinking citrus juices or hot liquids; persistent, unilateral ear pain; hoarseness or change in voice quality; persistent or recurrent sore throat; shortness of breath; and anorexia and weight loss.

The nurse is monitoring a client with leukemia who is receiving doxorubicin by intravenous infusion. The nurse should monitor for which finding that would indicate doxorubicin toxicity?

ECG Changes Cardiotoxicity can occur with the use of doxorubicin. The medication can produce irreversible toxicity to the heart, including ECG changes and heart failure. A red coloration of the urine may occur with the use of this medication, but this effect is harmless.

The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late sign or symptom of this oncological emergency?

Electrocardiographic changes

The nurse has admitted a client to the clinical nursing unit after undergoing a right mastectomy. The nurse should plan to place the right arm in which position?

Elevated on a pillow The client's operative arm should be positioned so that it is elevated on a pillow and not exceeding shoulder elevation. This position promotes optimal drainage from the limb, without impairing the circulation to the arm.

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?

Elevating the affected arm on a pillow above heart level Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.

The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan?

Encouraging fluids Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules.

A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client?

Enlarged lymph nodes Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to sites such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

The nurse develops a teaching plan regarding dysphagia and includes which interventions in the plan?

Examining the oral mucosa is a preventive intervention so that changes in the mucosa will be noted immediately. Inflammation and ulceration also occur because of rapid cell destruction, thereby impairing normal saliva excretion and distribution. Artificial saliva aids in preventing further damage by lubricating the affected area. The client with dysphagia has difficulty swallowing, not difficulty speaking. A client with difficulty swallowing should avoid drinking thin liquids because of the increased risk of aspiration owing to epiglottis dysfunction related to radiation therapy.

The oncology nurse specialist provides an educational session for nursing staff regarding the characteristics of Hodgkin's disease. A staff member states that which is a characteristic of the disease?

Hodgkin's lymphoma is a cancer that can occur at any age but appears to peak in 2 different age groups: in teens and young adults and in adults in their 50s and 60s. Reed-Sternberg cells are present. The lymph nodes, spleen, and liver are involved.

A client has had radical neck dissection and begins to hemorrhage at the incision site. The nurse should take which actions in this situation?

If the client begins to hemorrhage from the surgical site after radical neck dissection, the nurse elevates the head of the bed to maintain airway patency and prevent aspiration. The nurse applies pressure over the bleeding site and calls the surgeon immediately. The nurse also monitors the client's airway and vital signs.

A client is admitted to the nursing unit after undergoing radical prostatectomy for cancer. The nurse anticipates that which problem would be of most concern to the client in the immediate postoperative period?

In the immediate postoperative period, the client who has had surgery for cancer may experience fear or concern related to the uncertain outcome of surgery. The priority focus in the immediate postoperative period is not on concerns that apply to hospital discharge.

The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client?

Increase in serum calcium level Decrease in low-density lipoprotein levels Tamoxifen citrate is an anti-estrogen and antineoplastic medication. It may increase the calcium level and lower the low-density lipoprotein levels. The nurse should monitor for signs of hypercalcemia while the client is taking this medication. These signs include increased urine volume, excessive thirst, nausea, vomiting, constipation, decreased muscle tone, and deep bone or flank pain.

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder?

Increased calcium level Findings indicative of multiple myeloma are: - an increased number of plasma cells in the bone marrow - anemia - hypercalcemia caused by the release of calcium from the deteriorating bone tissue - elevated BUN. An increased white blood cell count may or may not be present

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy?

Increased uric acid level Hyperuricemia is especially common following treatment for leukemias and lymphomas, because chemotherapy results in massive cell destruction.

A community health nurse is providing an educational session on cancer of the cervix for women living in the community. The nurse informs the community residents that which is an early sign of this type of cancer?

Irregular vaginal bleeding or spotting Early cancer of the cervix usually is asymptomatic. The 2 chief symptoms are leukorrhea (vaginal discharge) and irregular vaginal bleeding or spotting. The vaginal discharge increases gradually in amount and becomes watery and finally dark and foul-smelling because of necrosis and infection of the tumor mass. As the disease progresses, the bleeding may become constant and may increase in amount.

The nurse is caring for a client with metastatic breast cancer. The client describes a new and sudden sharp pain in the back. Based on this assessment finding, which is the priority nursing intervention?

Notify the primary health care provider. Spinal cord compression should be suspected in a client with metastatic disease, particularly with sudden onset of new back pain. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression constitutes an oncological emergency, so the PHCP should be notified.

The community health nurse is instructing a group of young female clients about breast self-examination. The nurse should instruct the clients to perform the examination at which time?

One week after menstruation begins The breast self-examination should be performed regularly, 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.

The nurse is reviewing the medical record for a client who has been diagnosed with Hodgkin's disease. The nurse should check which diagnostic test noted in the client's record to determine the stage of the disease?

PET scan is used to diagnose and determine the stage of the disease. Diagnostic testing for this disorder includes blood studies, excisional lymph node biopsy, bone marrow examination, and radiographic studies. These tests are used for evaluation purpose but are not definitive.

The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings should the nurse expect to note?

Pathological fracture Urinalysis positive for Bence Jones protein Serum creatinine level of 2.0 mg/dL Urinalysis positive for nitrites The client with multiple myeloma may experience pathological fractures, hypercalcemia, anemia, recurrent infections, and renal failure. In addition, Bence Jones proteinuria is a finding.

The home care nurse visits a client who has just returned home from the hospital after a mastectomy with a suction drain in place. Which observed client behavior requires a need for further teaching?

Performs full range-of-motion exercises to the upper arm The client should be instructed to limit upper arm range-of-motion exercises to the level of the shoulder only. Once the suction drain has been removed, the client can begin full range-of-motion exercises to the upper arm as prescribed. The client should elevate the arm while sitting down or lying, and the client will be able to apply lotion to the incision once it has healed.

The nurse is caring for a client who has undergone a radical neck dissection and creation of a tracheostomy because of laryngeal cancer and is providing discharge instructions to the client. Which should be included in the instructions?

Protect the stoma from water. Use a humidifier if dryness is a problem. Keep powders and sprays away from the stoma site. Apply a thin layer of non-oil-based ointment to the skin around the stoma to prevent cracking. Air conditioners should be avoided to prevent excessive coldness

A client is having a diagnostic workup for colorectal cancer. Which factors in the client's history place the client at increased risk for this type of cancer?

This type of cancer most often occurs in populations with diets low in fiber and high in refined carbohydrates, fats, and meats. Other risk factors include a family history of the disease, rectal polyps, and active inflammatory disease of at least 10 years' duration.

The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication to treat breast cancer. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions?

Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the IV administration of an antineoplastic medication, the infusion is stopped and the PHCP is notified. Ice or heat may be prescribed for application to the site and an antidote may be prescribed to be administered into the site.

The community health nurse is preparing an educational class on ovarian cancer for a group of women. Which signs and symptoms should the nurse include in the presentation?

Signs and symptoms of ovarian cancer are often very subtle. Urinary urgency or frequency, abdominal or pelvic pain or swelling, vague gastrointestinal disturbances such as dyspepsia or gas, and unexplained weight loss are potential signs and symptoms and require further investigation.

The clinic nurse prepares instructions for a client diagnosed with leukemia who developed stomatitis after the administration of a course of antineoplastic medications. The nurse should provide the client with which instruction?

Rinse the mouth with a diluted solution of baking soda or saline. Stomatitis (ulceration in the mouth) can result from the administration of antineoplastic medications. The client should be instructed to examine the mouth daily and report any signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with a diluted solution of baking soda or saline. Food and fluid are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet that includes milkshakes and ice cream. Instruct the client to avoid spicy foods and foods with hard crusts or edges. The client should avoid brushing the teeth, particularly with a stiff-bristled toothbrush, and flossing when stomatitis is severe.

The community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster?

Risk factors for breast cancer include nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries.

A client with laryngeal cancer has undergone laryngectomy and is now receiving external radiation therapy to the head and neck. The nurse should monitor the client for which side and adverse effects of external radiation?

Stomatitis (inflammation of the mucous lining in the mouth) dysgeusia (distorted sense of taste) xerostomia (dry mouth) these are all local effects of external radiation to the head and neck.

The nurse has provided instructions to a client regarding testicular self-examination (TSE). Which client statement indicates understanding?

TSE should be performed every month. Small lumps or abnormalities should be reported. The spermatic cord finding (a hard cord in the back and going up) is normal. After a warm bath or shower, the scrotum is relaxed, making it easier to perform TSE.

The nurse is instructing a client to perform a testicular self-examination (TSE). The nurse should provide the client with which information about the procedure?

That the best time for the examination is after a shower The TSE is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with fingers under the scrotum and thumbs on top, the client should gently roll the testicles, feeling for any lumps.

The nurse is providing care to a client who has undergone modified right mastectomy for the treatment of breast cancer. Which activity should the nurse incorporate into the plan of care?

The client should have the head of the bed elevated at least 30 degrees with the affected arm elevated on a pillow. Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. All staff must avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood.

A client is being treated preoperatively with radiation therapy. What statement by the client demonstrates understanding of proper care of the skin over the treatment field?

The client undergoing radiation therapy should avoid washing the site until instructed to do so. The client should then wash, using mild soap and warm or cool water, and pat the area dry. No lotions, creams, alcohol, or deodorants should be placed on the skin over the treatment site. Lines or ink marks that are placed on the skin to guide the radiation therapy should be left in place. The affected skin should be protected from temperature extremes, direct sunlight, and chlorinated water (as from swimming pools).

The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse include in discharge instructions?

The client who has undergone a prostatectomy should avoid lifting objects heavier than 20 lb. for at least 6 weeks. Driving a car and sitting for long periods are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Small pieces of tissue or blood clots may be passed during urination for up to 2 weeks after surgery; this is an expected occurrence.

A client who has undergone radical neck dissection for a tumor has a potential problem of obstruction related to postoperative edema, drainage, and secretions. To promote adequate respiratory function in this client, the nurse should implement which activities?

The client's respiratory status is promoted by the use of high-Fowler's position after this surgery. Low-Fowler's position is avoided because it could result in increased venous pressure on the surgical site and increased risk of regurgitation and aspiration. It also is helpful to encourage the client to cough and deep breathe every 2 hours, to support the neck incision when coughing, to suction periodically as needed, and to monitor the respiratory status frequently as prescribed.

The nurse is preparing a list of home care instructions regarding stoma and laryngectomy care for a client with laryngeal cancer who had a laryngectomy. Which instructions should be included in the list?

The nurse should teach the client how to care for the stoma, depending on the type of laryngectomy performed. Most interventions focus on protection of the stoma and the prevention of infection. Interventions include obtaining a MedicAlert bracelet, preventing debris from entering the stoma, avoiding exposure to people with infections, and avoiding swimming and using care when showering. Additional interventions include wearing a stoma guard or high-collared clothing to protect the stoma, increasing the humidity in the home, and increasing fluid intake to 3000 mL/day to keep the secretions thin.

The nurse should include which intervention in the care of a client who has undergone a vaginal hysterectomy for the treatment of cancer?

The nurse will implement measures that prevent DVT or thrombophlebitis; ROM exercises, ambulation, anti-embolism stockings, and pneumatic compression boots are all helpful.

The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function?

The passage of flatus Following abdominal perineal resection, the nurse would expect the colostomy to begin to function within 72 hours after surgery, although it may take up to 5 days. The nurse should assess for a return of peristalsis, listen for bowel sounds, and check for the passage of flatus. Absent bowel sounds would not indicate the return of peristalsis. The client would remain NPO (nothing by mouth) until bowel sounds return and the colostomy is functioning.

The nurse in the primary health care provider's office is performing a postoperative assessment of a client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should provide which information to the client about her complaint?

These sensations dissipate over several months and usually resolve after 1 year. Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow is a result of injury to the nerves that provide sensation to the skin in those areas. These sensations may be described as heaviness, pain, tingling, burning, or "pins and needles." These sensations are not a sign of a complication and are not permanent.

A client with testicular cancer is receiving cisplatin. The nurse assesses for which finding as a toxic effect of this medication?

Tinnitus Cisplatin can cause neurotoxicity, nephrotoxicity, bone marrow depression, and ototoxicity, which manifests as tinnitus and high-frequency hearing loss. Nausea and vomiting are expected side effects, which can be severe and begin 1 hour after administration, persisting for 1 to 2 days.

The community health nurse is preparing an educational session for a group of women and will be discussing the primary prevention strategies and treatment measures for breast cancer. What information should the nurse include in the educational session?

Treatment decisions are based on a woman's overall health. Breast cancer occurs most often in women who are 65 years of age or older, and older women are less likely to have mammograms. Rather than using the woman's age to decide on screening and treatment measures, the woman's overall health is used to make these determinations, since health status has a greater influence on tolerance to treatment.

The nurse is taking a history from a client suspected of having testicular cancer. Which data will be most helpful in determining the risk factors for this type of cancer?

Two basic but important risk factors for testicular cancer are age and race. The disease occurs most frequently in white males, generally between the ages of 15 and 34 years. Other risk factors include a history of undescended testis and a family history of testicular cancer. The number of sexual partners is not associated with testicular cancer.

The nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. The nurse should teach the client to put the pillow in which location for self-examination of the right breast?

Under the right shoulder The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder and vice versa.