NCM 112 - Oncology
The nurse has provided instructions to a client who is receiving external radiation therapy. Which statement by the client indicates a need for further instructions regarding self-care related to radiation therapy? 1 "I need to eat a high-protein diet." 2 "I need to avoid exposure to sunlight." 3 "I need to wash my skin with a mild soap and pat it dry." 4 "I need to apply pressure on the irritated area to prevent bleeding.
"I need to apply pressure on the irritated area ip prevent bleeding." Rationale:The client receiving external radiation therapy should avoid pressure on the irritated area and wear loose-fitting clothing. Specific physician instructions would be necessary to obtain if an alteration in skin integrity occurred as a result of the radiation therapy. Options 1, 2, and 3 are accurate measures regarding radiation therapy.
The nurse has explained the reason that the physician has chosen laser surgery to treat a client's cervical cancer. Which statement by the client indicates an understanding of the explanation? - "The doctor is able to see all the edges of my cancer clearly." - "I am young and the laser prevents cancer tissue from regrowing." - "I want to be asleep during the procedure." - "I have too much cancer to be removed with surgery."
"The doctor is able to see all the edges of my cancer clearly."
A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? - "I have a vase in the utility room, and I will get it for you." - "I will get the vase and wash it well before you put the flowers in it." - "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." - "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."
"The flowers from your garden are beautiful, but should not be placed in the child's room at this time."
The nurse is performing an assessment on a 10-year-old female child suspected to have hodgkin's disease. Which assessment findings are specifically characteristics of this disease? Select all that apply. - Fever and malaise - Abdominal pain - Anorexia and weight loss - Painless, firm, and moveable adenopathy in the cervical area - Painful, enlarged inguinal lymph nodes
- Abdominal pain - Painless, firm, and moveable adenopathy in the cervical area
A 4 year old admitted for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomagly are noted. Diagnostic studies are being performed because acute lympocytic leukemia is suspected. The nurse determines that which lab results confirms the diagnosis. - Lumbar puncture showing no blast cells - White blood cell count 4500 mm3 - Platelet count of 350,000 mm3 - Bone marrow biopsy showing blast cells
- Bone marrow biopsy showing blast cells
Two months after a right mastectomy for breast cancer, a client comes to the office for the follow up check up appointment. After being diagnosed with cancer in the righ breast, the client was told the risk for cancer in the left breast existed. When asked about her breast self-examination (BSE) practices since the surgery, the clinet replied, "I don't need to do that anymore." The nurse interprets that this response may indicate: - Denial - Change in role pattern - Grief and mourning - Change in body image
- Denial
Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. - Ensure that anyone entering the child's room wears a mask - Use a strict asepic technique for all proceudres - Apply firm pressure to a needle-stick area for at least 10 minutes - Maintain the child in semiprivate room - Reduce exposure to environmental organisms
- Ensure that anyone entering the child's room wears a mask - Use a strict asepic technique for all proceudres - Reduce exposure to environmental organisms
The nurse is monitoring a child for bleeding after surgery for the removal of a Brain tumor. The nurse checks the head dressin for the presence of blood and notes colorless draiage on the back fo the dressing. Which intervention should the nurse perform immediately? - Notify the health care provider - Reinforce the dressing - Circle the area of drainage and continue to monitor - Document the findings and continue to monitor
- Notify the health care provider Rationale: Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately. Options 1, 3, and 4 are not the immediate nursing intervention because they do not address the need for immediate intervention to prevent complications.
Patient receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? Select all that apply. - Gently insert rectal suppositories - Provide a soft toothbrush or oral sponge - Provide mouthwash with alcohol for oral rinsing - Use paper tape on fragile skin - Avoid overinflation of blood pressure cuffs - Avoid aspirin or aspirin - containing products
- Provide a soft toothbrush or oral sponge - Use paper tape on fragile skin - Avoid overinflation of blood pressure cuffs - Avoid aspirin or aspirin - containing products
A client is admitted to the hospital with a diagnosis of infiltrating ductal carcinoma of the breast. The nurse assess the client for which expected manifestation? - Pain in the breast and edema - A round- shaped mass that is moveable - A fixed, irregularly shaped mass. - Bilateral palpable masses
A fixed, irregularly shaped mass
A client is admitted to the hospital with a diagnosis of infiltrating ductal carcinoma of the breast. Which expected manifestation should the nurse assess the client for? - Bilateral palpable masses - Pain in the breast and edema - A fixed, irregularly shaped mass - A round-shaped mass that is moveable
A fixed, irregularly shaped mass
A post-mastectomy client has been found to have an estrogen-receptor positive tumor. The nurse interprets after reading this information in the pathology report that the client will most likely have which common follow-up treatment prescribed? - Removal of ovaries - Administration of tamoxifen - Administration of progesterone - Administration of estrogen
Administration of tamoxifen (Nolvadex)
A patient who has cancer will need ongoing treatment for pain. Which brochure is the nurse most likely to prepare that addresses questions related to the first line treatment of cancer pain? - How to make preparations for yoru cancer surgery - An illustrated guide to the analgesic ladder - Common questions about radiation therapy - How nerve vlocks can help to manage cancer pain
An illustrated guide to the analgesic ladder
Which patient is at greatest risk for pancreatic cancer? - An older african - american who smokes - A young white obese woman with gallbladder disease - A young african - american with type 1 diabetes mellitus - An elderly white woman who has pancreatitis
An older african - american who smokes
A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While the nurse is trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority nursing concept to consider in responding to this patient? - Diarrhea/Constipation related to altered bowel patterns - Deficient Knowledge related to the disease process and diagnostic procedure - Risk for Deficient Fluid Volume related to rectal bleeding and diarrhea - Anxiety related to unknown outcomes and perceived threats to body integrity
Anxiety related to unknown outcomes and perceived threats to body integrity
The nurse is caring for a patient with esophageal cancer. Which task could be delegated to the nursing aide? - Assist the patient with oral hygiene. - Observe the patient's response to feedings. - Facilitate expression of grief or anxiety. - Initiate daily weights.
Assist the patient with oral hygiene.
A 32 year old female client has a history of fibrocystic disorder of the breasts. The nurse determines that the client understands the nature of the disorder if the client states that symptoms are more likely to occur: - After menses - Before menses - In the winter months - In the spring months
Before menses Rationale: The client with fibrocystic breast disorder experiences worsening of symptoms (breast lumps, painful breasts, and possible nipple dis-charge) before the onset of menses. This is associated with cyclical hormone changes. Clients should understand that this is part of the clinical picture of this disorder. Options 1, 3, and 4 are incorrect.
The nurse is caring for a client with cancer of the lung who is receiving chemotherapy. The nurse reviews the laboratory results and notes that the platelet count is 18,000/mm3. Based on this laboratory result, which of the following would the nurse implement? - Bleeding precautions - Neutropenic precautions - Contact precautions - Respiratory precautions
Bleeding precautions Rationale: If platelets are down, it is prone to bleeding tendencies. Normal platelet count is 150,000 to 140,000
A client who has been admitted to a surgical unit with a diagnosis of cancer is scheduled for surgery in the morning. When the nurse enters the room and begins the surgical preparation, the client states, "I'm not having surgery—you must have the wrong person! My test results were negative. I'll be going home tomorrow." The nurse recognizes that the ego defense mechanism that me be operating here is: - Delusions - Displacement - Denial - Psychosis
Denial Rationale: Defense mechanisms protect us against anxiety. Denial is the defense mechanism used to block out painful or anxiety-inducing events or feelings. In this case, the client cannot deal with the upcoming cancer surgery and therefore denies that he or she is ill. Psychosis and delusions are not defense mechanisms. Displacement is acting out in anger or frustration with people who did not arouse the feelings.
An experienced nurse is precepting a newly hired nurse who has two years of medical surgical experience but limited experience with patients who have cnacer. The new hire seems to be consistently undermedicating the patient's pain. What should the preceptor do first? - Reassess all of the patients and administer additional pain medication as needed - Determine the new nurse's understanding and beliefs about cancer pain and treatments - Ask the new nurse about past experiences in administering pain medications - Write an incident report and inform the nurse manager about the nurse's performance
Determine the new nurse understanding and beliefs about cancer pain and treatments.
The night shift nurse tell sthe incoming dayshift nurse that the cancer patient is on around-the-clock dosing of morphine but the paitnet might be having end-of-dose pain. Which question is the most important to ask the night shift nurse? - Did the patient tell you that the pain was greater than a 5/10? - How many times did you have to give a bolus dose of morphine? - Did you notify the health care provider and were changes prescribed? - Did you try any non pharmaceutical therapies or adjuvant medications?
Did you notify the healthcare provider and were changes prescribed?
The nurse is caring for a client who has just had a mastectomy. The nurse assists the client in doing in doing which of the following exercises during the first 24 hours? - Shoulder abduction and external rotation - Pendulum arm swings - Elbow flexion and extension - Hand wall climbing
Elbow flexion and extension Rationale: During the first 24 hours after surgery, the client is assisted to move the fingers and hands, and to flex and extend the elbow. The client may also use the arm for self-care provided that she does not raise the arm above shoulder level or abduct the shoulder. The exercises identified in options 1, 2, and 4 are done once surgical drains are removed and wound healing is well established.
The nurse assesses the patient and determines that the patient is having frequent breakthrough cancer pain. Which member of the health care team is the nurse most likely to cantact first? - Nursing aide to provide more assistance with activities of daily living - Physical therapist to reevaluate physical therapy routines - Health care provider to review medication, dosage, and frequency - Psychiatric clinical nurse specialist to evaluate psychogenic pain
Health care provider to review medication, dosage, and frequency
During the nursing assessment, the client states, "My doctor just told me that my cancer has spread, and I have less than 6 months to live." Which of the following nursing responses would be therapeutic? - "I know it seems desperate, but there have been a lot of breakthroughs. Something might come along in a month or so to change your status drastically." - "I am sorry. Would you like to discuss this with me some more?" - "I hope you'll focus on the fact that your doctor says you have 6 months to live and that you'll think of how you'd like to live." - "I am sorry. There are no easy answer in times like this are there?"
I am sorry. Would you like to discuss this with me some more?
The nurse has provided instructions to a client regarding testicular self-examination (TSE). Which client statement indicates the need for further teaching regarding TSE? - "I know to report any small lumps." - "I should examine myself every 2 months." - "I should examine myself after I take a warm shower." - "I know it's normal to feel something that is cord-like in the back.
I examine myself every 2 months. Rationale: TSE should be performed every month. Small lumps or abnormalities should be reported. The spermatic cord finding is nor-mal. After a warm bath or shower, the scrotum is relaxed, which makes it easier to perform TSE.
When planning for the care of the client who is dying of cancer, one of the goals is that the client verbalize his or her acceptance of impending death. which client statement indicates to the nurse that this goal has been reached? - "I'll be ready to die when my children finish school" - "I just want to live until my 100th birthday" - "I want to go to my daughters' wedding. Then, I'll be ready to die" - "I would like to have my family here when i die"
I would like to have my family here when i die
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19, 500 mm^3. (19.5^10^9/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care? - Initiate protective isolation precautions - Monitor closely for signs of infection - Initiate bleeding precautions - Monitor the temperatue every four hours
Initiate bleeding precautions Rationale: If platelets are below 150,000 (thrombocytopenia), it is prone to bleeding.
The nurse is caring for a 25-year-old single client who will undergo a bilateral orchiectomy for testicular cancer. The nurse should make it a priority to explore which potential psychological concern with this client. - Length of recuperative period - Postoperative pain - Loss of reproductive ability - Postoperative swelling
Loss of reproductive ability Rationale: Although the client will need factual information about the postoperative period and recuperation, the nurse should place priority on addressing loss of reproductive ability as a psychological concern. The radical effects of this surgery in the reproductive area make it likely that the client may have some difficulty in adjustment to this consequence of surgery.
The patient describes a burning sensation in the leg. The health care provider tells the nurse that a medication will be prescribed for neuropathic pain secondary to chemotherapy. The nurse is most likely to question the prescription of which drug? - Imipramine - Carbamazepine - Gabapentin - Morphine
Morphine is usually not prescribed for neuro- pathic pain because pain relief response is poor. Other medications, some antidepressants (e.g., imipramine) and some anticonvulsants (e.g., carbamazepine and gabapentin), provide better relief. Focus: Prioritization.
The physician tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement is cause for greatest concern? - My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death - Initially, I may have to take some time off work for my treatments; I can probably work full time in the future. - My symptoms will eventually be cured; I'm so happy that I don't have to worry any longer - My doctor is trying to help me control the symptoms; I am grateful for the extension of time with my family
My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death
A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is ele- vated, and the blood pressure has decreased signif- icantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? - Increase the flow rate of the intravenous fluids - Place the child in Trendelenburg position - Notify the health care provider - Place the child in supine position
Notify the health care provider (HCP).
Which nurse is demonstrating the first step in managing cancer pain by using the ABCDE (Ask, Believe, Choose, Deliver, and Empower) clinical approach to pain management as recommended by the Agency for Healthcare Research and Quality? - Nurse J asks if the time of the prescribed dose medication can be changed - Nurse M asks about pain management options that are appropriate for the patient - Nurse L asks the patient to participate and to contribute in pain management - Nurse K asks the patient to describe pain and uses a numerical pain scale.
Nurse K asks the patient to describe pain and uses a numerical pain scale.
A client with renal cell carcnoma of the left kidney is scheduled for nephrectomy. The right kidney appears normal at this time. The client is anxious about whether dialysis will ultimately be needed. The nurse should plan to use which information in discussions with the client to alleviate anxiety? - There is a strong likelihood that the client will need dialysis within 5 to 10 years. - There is absolutely no chance of needing dialysis because of the nature of the surgery. - One kidney is adequate to meet the needs of the body as long as it has normal function. - Dialysis could become likely, but it depends on how well the client complies with fluid restriction after surgery.
One kidney is adequate to meet the needs of the body as long as it has normal function Rationale: Fears about having only one functioning kidney are common among clients who must undergo nephrectomy for renal cancer. These clients need emotional support and reassurance that the remaining kidney should be able to fully meet the body's metabolic needs as long as it has normal function. Options 1, 2, and 4 are incorrect statements.
The mother of a 4 year old child brings the child to the clinic and tells the pediatric nurse specialist that the child's abdomen seems to be swollen. During further assessment of the subjective data, the mother tells the nurse that the child has been eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of a Wilm's tumor, would avoid which of the following during the physical assessment? - Monitoring the blood pressure for the presence of hypertension - Assessing the urine for the presence of hematuria - Monitoring the temperature for the presence of fever - Palpating the abdomen for a mass.
Palpating the abdomen for a mass. Rationale: Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor.
Which patient is at greatest risk for pancreatic cancer? - An older African-American man who smokes - A young white obese woman with gallbladder disease - A young African-American man with type1 diabetes - An elderly white woman who has pancreatitis
Pancreatic cancer is more common in African Americans, men, and smokers. Other associated fac- tors include older age, alcohol use, diabetes, obesity, history of pancreatitis, exposure to organic chemicals, consumption of a high-fat diet, and previous abdomi- nal irradiation. Focus: Prioritization.
A community health center is preparing a presentation on the prevention and detection of cancer. Which task would be best to assign to a nursing aide? - Explain screening examinations and diagnostic testing for common cancers - Discuss how to plan a balanced diet and reduce fats and presevatives - Prepare a poster on the seven warning signs of cancer - Describe strategies for reducing risk factors such as smoking and obesity
Prepare a poster on the seven warning signs of cancer
A client has undergone mastectomy. The nurse determines that the client is having the most difficulty adjusting to loss of the breast if which behavior is observed? - Reads the postoperative care booklet - Performs arm exercises - Refuses to look at the dressing - Request pain medication when needed.
Refuses to look at the dressing
The school nurse is planning to give a class on testicular self-examination (TSE) at a local high school. The nurse plans to include which instruction on a written handout to be given to the students. - Expect the self-examination to be slightly painful. - Roll the testicle between the thumb and forefinger. - Perform the self-examination every month - Perform the self-examination after a cold shower.
Roll the testicle between the thumb and forefinger.
The nurse is preparing a a poster for a booth at a health fair to promote the primary prevention of cervical cancer. The nurse includes which recommendation of the poster? - Perform montly brest self-examination (BSE) - Use a commercial douche on a daily basis. - Use oral contraceptives as a preferred method of birth control. - Seek treatment promptly for infections of the cervix.
Seek treatment promptly for infections of the cervix.
The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? - The femur is the most common site of this sarcoma. - The child does not experience pain at the primary tumor site. - Limping, if a weight-bearing limb is affected, is a clinical manifestation. - The symptoms of the disease in the early stage are almost always attributed to normal growing pains.
The child does not experience pain at the primary tumor site.
A client with cancer is placed on permanent parenteral nutrition as a means of providing nutrition. The nurse includes psycho-social support when planning care for this client because: - Client will need to adjust to the idea of living without eating by the usual route. - Death is imminent - Parenteral nutritional requires disfiguring surgery for permanent port implantation. - Nausea and vomiting occur regularly with this type of treatment and will prevent the client from participating in social activity.
The client will need to adjust to the idea of living without eating by the usual route.
A diagnosis of Hodgkin's disease is suspected in a 12-year-old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? - Elevated vanillylmandelic acid urinary levels - The presence of blast cells in the bone marrow - The presence of Epstein-Barr virus in the blood - The presence of Reed-Sternberg cells in the lymph nodes
The presence of Reed-Sternberg cells in the lymph nodes
The nurse is caring for a client with cancer who has a nursing diagnosis of Disturbed Body Image related to Alopecia. The nurse plans to teach the client about which of the following that is related to this nursing diagnosis? - Proper dental hygiene with the use of a foam toothbrush. - The importance of rinsing the mouth after eating. - The use of cosmetics to hide drug-induced rashes. - The use of wigs, which are often covered by insurance.
The use of wigs, which are often covered by insurance.
An older patient needs treatment and relief for severe localized pain related to postherpetic neuralgia that developed during chemotherapy. The nurse is most likely to question the prescription of which type of medication? - Capsaicin patch - Gabapentinoid - Lidocaine patch - Tricyclic antidepressant
Tricyclic antidepressant
A client has had a left mastectomy with axillary lymph node dissection. The nurse determines that the client understands postoperative restrictions and arm care if the client states to: - Use gloves when working in the garden - Carry a handbag and heavy objects on the left arm. - Allow blood pressures to be taken only on the left arm. - Use straight razor to shave under the arms.
Use gloves when working in the garden
The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to mon- itor for which early sign or symptom of increased ICP? - Vomiting - Complaints of a frontal headache - Increasing head circumferene - Bulging anterior fontanel
Vomiting
The nurse inspects the skin of a client receiving external radiation therapy and documents a finding as moist desquamation. The nurse understands that moist desquamation is best described as which? - Reddened skin - Weeping of the skin - Dermatitis - A rash
Weeping of the skin
For a patient who is receiving chemotherapy, which laboratory result is of particular importance? - White blood cells - Electrolyte levels - Blood urea nitrogen level - Prothrombin time
White Blood Cells
For a patient receiving the chemotherapeutic drug vincristine, which side effects should be reported to the health care provider? - Anorexia - Fatigue - Paresthesia - Nausea
paresthesia
For the patient who is experiencing side effects of radiation therapy, which task would be most appropriate to delegate to a nursing aide? - Checking the skin for redness and irritation after treatment - Reporting the amount and type of food consumed from the tray - Helping the patient to identify patterns of fatigue - Recommending participation in a walking program
reporting the amount and type of food consumed from the tray
Client has laryngectomy for throat cancer and has started oral intake. The nurse determines that the client has tolerated the first stage of dietary advancement if the client takes which of the following types of diet without aspirating or choking? - Clear liquids - Bland - Semisolid foods - Full liquids
semisolid Rationale: Oral intake after laryngectomy is started with semisolid foods. When the client can manage this type of food, liquids may be introduced. Thin liquids are not given until the risk of aspiration is negligible. A bland diet is not appropriate. The client may not be able to tolerate the texture of some of the solid foods that would be included in a bland diet.
A client had a positive papanicolaou smear and underwent cryosurgery with laster therapy. The nurse should provide the client with which piece of information before letting the client go home. - Sitz baths are soothing to the irritated tissues. - Vaginal discharged should be clear and watery - Pain can be relieved with opiod analgesics - There should be absolutely no odor or vaginal discharge
vaginal discharge should be clear and watery Rationale: Cryosurgery is a procedure that involves freezing cervical tissues. Vaginal discharge should be clear and watery after the procedure. The client will then begin to slough off dead cell debris, which may be odorous. This resolves within approximately 8 weeks. Tub and sit baths are avoided while the area is healing, which takes about 10 weeks. There is mild pain after the procedure, and opioid analgesics would not be required.
A client is preparing for discharge 10 days after a radical vulvectomy. The nurse determines that the client has the best understanding of the measures to prevent complications if the client plans to do which of the following after discharge? - Walk - Do housework - Sit in a chair all day - Drive a car
walk
