Oncologic Disorders

A client with lung cancer is being cared for by their spouse at home. The client's pain is increasing in severity. The nurse recognizes that teaching has been effective when the spouse uses which pain relief strategy? Select all that apply. substitutes acetaminophen to avoid tolerance to the medications uses an immediate-release medication (oxycodone) for breakthrough pain avoids long-acting opioids because of the client's concern about addiction gives the client a long-acting or sustained-release oral pain medication regularly around the clock uses music for distraction as well as heat or cold in combination with medications has the client use a pain rating scale to measure the effectiveness of reaching their individual pain goal

-gives the client a long-acting or sustained-release oral pain medication regularly around the clock -uses an immediate-release medication (oxycodone) for breakthrough pain -uses music for distraction as well as heat or cold in combination with medications -has the client use a pain rating scale to measure the effectiveness of reaching their individual pain goal Explanation: The scheduled use of long-acting opioids and around-the-clock dosing are necessary to achieve a steady level of analgesia. Whatever the route or frequency, a prescription should be available for breakthrough pain medication to be administered in addition to the regularly scheduled medication. Oral drug administration is the route of choice for economy, safety, and ease of use. Even severe pain requiring high doses of opioids can be managed orally as long as the client can swallow medication and has a functioning gastrointestinal system. Tolerance occurs because of the need for increasing doses to achieve the same pain relief and will not be avoided with the use of acetaminophen. Addiction is a complex condition in which the drug is used for psychological effect and not analgesia. Nurses need to educate families about the appropriate use of opioids and assure them that addiction is not a concern when managing cancer pain. Nonpharmacologic methods are useful as an adjunct to assist in pain control. Self-report is the best assessment of pain and is an individual response.

The nurse is collaborating with the health care provider (HCP) to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan is most appropriate for preventing and reducing the client's pain? Encourage the client to avoid intravenous pain medication until the condition has reached the terminal stage. Administer analgesics when the client's vital signs indicate that the severity of the pain is increasing. Keep the client sedated with tranquilizers to prevent awareness of pain sensations. Administer analgesics on a regular basis with administration of additional analgesics for breakthrough pain.

Administer analgesics on a regular basis with administration of additional analgesics for breakthrough pain. Explanation: Maintaining a steady blood level of analgesics is beneficial for the client with chronic cancer pain. Administering analgesics on a regular basis helps to control pain more efficiently. It may also be necessary for the client to have additional doses of medication ordered to be administered for breakthrough pain. Keeping the client overly sedated may not help to control pain, and intravenous analgesics are more effective at controlling pain as they are more predictable in their distribution than many oral medications. Vital signs are not a reliable indicator of how much pain the client is experiencing.

After the physician explains the risks and benefits of a clinical trial to a client, the client agrees to participate. Later that day, the client requests clarification of the process involved in the clinical trial. As a member of the multidisciplinary team, how should the nurse respond? Encourage the client to withdraw from the trial. Tell the client that the information should come from the physician who first presented it to them. Not provide the information because it's beyond the scope of nursing practice. Provide the information requested.

Provide the information requested. Explanation: As part of the multidisciplinary team, the nurse is empowered to assist the client to better understand the process, as long as the nurse has an understanding of the treatment plan. The nurse shouldn't discourage the client from participating in the research study. Providing information to the client about the clinical trial isn't beyond the scope of nursing practice. The information doesn't need to come from the physician who originally presented the material to the client.

A client receiving chemotherapy for cervical cancer indicates that she has an advance directive. She tells the nurse that she worries her children will not honor her wishes if her condition should worsen. In order to facilitate the honoring of the client's wishes, what should the nurse encourage the client to do? Appoint a proxy who is not a family member. Obtain additional legal documents. Recommend that the client contact her attorney. Discuss her end-of-life wishes with her family.

Discuss her end-of-life wishes with her family. Explanation: Family opposition does not override an advance directive. However, the client should ensure that family members know what her wishes are, even if they do not agree with them. After discussing her wishes with her family, the client can decide if she should seek additional legal advice, obtain legal documents, or name an outside proxy.

While changing bed linens the nurse notices a metal object on the bottom sheet of a client with radiation seeds implanted in the bladder. Which action should the nurse take? Select all that apply. Walk away from the item. Notify the radiation department. Place the object on the bedside table. Scoop the item with a tissue and place in the trash. Place the object on the sink in the bathroom.

Walk away from the item. Notify the radiation department. Explanation: A radiation seed that is outside of the body will continue to emit radiation particles. Moving away from the object should be done immediately and the radiation department notified so that appropriate personnel can remove the object. The object should not be touched to place on the bedside table, on the sink, or placed in the trash.

The nurse is caring for a client who is receiving external beam radiation therapy for the treatment of lung cancer. What should the nurse assess the client for while they are receiving radiation therapy? normal white blood cell count diarrhea dysphagia improved energy level

dysphagia Explanation: Radiation-induced esophagitis with dysphagia is particularly common in clients who receive radiation to the chest. The anatomic location of the esophagus is posterior to the mediastinum and is within the field of primary treatment. Diarrhea may occur with radiation to the abdomen. A decreased energy level and a decreased white blood cell count are potential complications of radiation therapy

A client with advanced vaginal cancer asks the nurse, "What is the usual treatment for this type of cancer?" Which treatment should the nurse name? chemotherapy radiation surgery immunotherapy

radiation Explanation: The usual treatment for advanced vaginal cancer is radiation. Chemotherapy typically is ordered only if vaginal cancer is diagnosed in an early stage, which is rare. Rarely, surgery may be combined with radiation. Immunotherapy isn't used to treat vaginal cancer.

A nurse is caring for a client with bronchogenic carcinoma. Which nursing intervention takes highest priority? offering frequent rest periods removing pulmonary secretions allowing the client to express concerns improving nutritional status

removing pulmonary secretions Explanation: Maintaining a patent airway is the first concern in a client with a condition that may compromise the airway. Therefore, adequate removal of pulmonary secretions is a priority. Although clients may exhibit fatigue, anxiety, or appetite loss, these need to be addressed, but are not the priority.

A client receiving chemotherapy has pruritus. To develop a care plan, the nurse should ask the client about which measure? wearing clothes made from 100% cotton taking daily baths with deodorant soap increasing fluid intake to at least 12 cups (about 3 L) a day sleeping in a cool, humidified room

taking daily baths with deodorant soap Explanation: The use of deodorant or fragrant soaps is drying to the skin. Cotton clothing gives the least irritation to the skin. A cool, humidified environment adds to the client's comfort and provides hydration for skin comfort. A fluid intake of 12 cups (about 3 L) a day is recommended for adequate hydration.

A client's spouse expresses concern that the dying client keeps saying, "I have to go to the store." Which statement by the nurse will be most effective in assisting the spouse to understand the dying process? "Comments related to going somewhere or leaving on a trip are common in dying clients." "The client may be fighting death, and you should leave them alone." "You can tell your spouse that you will take them to the store." "Many dying clients are restless and can be treated with sedatives."

"Comments related to going somewhere or leaving on a trip are common in dying clients." Explanation: Mental changes and decreased level of consciousness are common in the dying process, and the client may talk about travel, trips, or going somewhere. Suggesting that the client be sedated ignores the spouse's question about what the client is experiencing. Suggesting that the client is fighting death and that the spouse should leave them alone is inappropriate and denies the spouse time to spend with the client. The spouse should not make misleading statements to the client.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching? "I'll not use my heating pad during my treatment." "I'll wash my skin with mild soap and water only." "I'll wear protective clothing when outside." "I'm worried I'll expose my family members to radiation."

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

The nurse is instructing a client on how to care for skin that has become dry after radiation therapy. Which statement by the client indicates that they understand the teaching? "It's safe to apply a nonperfumed lotion to my skin." "I should take antihistamines to decrease the itching I'm experiencing." "I can apply an over-the-counter medicated ointment to relieve the dryness." "A heating pad, set on the lowest setting, will help decrease my discomfort."

"It's safe to apply a nonperfumed lotion to my skin." Explanation: Irradiated skin can become dry and irritated, resulting in itching and discomfort. The client should be instructed to clean the skin gently and apply nonperfumed, nonirritating lotions to help relieve dryness. Taking an antihistamine does not relieve the skin dryness that is causing the itching. Heat should not be applied to the area because it can cause further irritation. Medicated ointments should not be applied to the skin without the prescription of the radiation therapist.

Blood administration is ordered for a client receiving chemotherapy. The nurse is obtaining all supplies needed for infusion. Which intravenous solution is obtained?

0.9% sodium chloride injection USP Explanation: Normal saline solution (0.9 NS) is the only fluid compatible with blood administration. Lactated Ringers and dextrose solutions are not infused with blood products due to compatibility.

Which client has the highest risk of ovarian cancer? 45-year-old woman who has never been pregnant 30-year-old woman taking hormonal contraceptives 36-year-old woman who had her first child at age 22 40-year-old woman with three children

45-year-old woman who has never been pregnant Explanation: The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.

Which client does the nurse determine has the highest risk for developing ovarian cancer? 60-year-old obese woman who has never been pregnant 50-year-old woman who has had multiple pregnancies 35-year-old woman who breast fed one of her four children 45-year-old woman taking oral contraceptives for 5 years

60-year-old obese woman who has never been pregnant Explanation: Risk factors for ovarian cancer include age over 55, body mass index over 30, and inherited gene mutations (BRCA I and II). Interrupting the menstrual cycle by means of oral contraceptives, pregnancy, and breast feeding are considered protective factors.

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? Impaired swallowing Disturbed body image Chronic low self-esteem Anticipatory grieving

Anticipatory grieving Explanation: Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn't associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn't disfiguring and doesn't cause Disturbed body image. Chronic low self-esteem isn't an appropriate nursing diagnosis at this time because the diagnosis has just been made.

A client has been receiving chemotherapy for cancer treatment. The client is competent and has been actively involved in decisions regarding care; however, the client has now decided to refuse treatment. What should the nurse do when the client refuses the next dose of chemotherapy? Ask the client's spouse to encourage the client to take the chemotherapy. Ensure that the client understands the rationale for taking the medication. Document the client's choice and offer to discuss feelings about the chemotherapy. Persuade the client to take the medication as ordered.

Document the client's choice and offer to discuss feelings about the chemotherapy. Explanation: The client has the right to choose whether to take the medication. The nurse should try to determine the reason for the client not wanting the medication other than choice (e.g., side effects, fear of falling asleep and not waking). The other options do not allow for client choice or consent.

A client receiving chemotherapy for cancer has an elevated serum creatinine level. What should the nurse do next? Cancel the next scheduled chemotherapy. Administer the scheduled dose of chemotherapy. Notify the health care provider (HCP). Obtain a urine specimen.

Notify the health care provider (HCP). Explanation: Nephrotoxicity caused by chemotherapy is assessed by monitoring the serum creatinine level. Creatinine is the most sensitive indicator of proper kidney function. In this case, the client is experiencing decreased kidney function, most likely due to the chemotherapy. The nurse consults the HCP for guidance. Administering the next dose of chemotherapy could potentially cause further kidney damage. It is inappropriate to cancel the chemotherapy without checking with the HCP or to tell the client that the cancer is spreading. A urine specimen will not provide other helpful information.

A client with a history of a left radical mastectomy is being admitted for abdominal surgery. The client has a swollen left arm. What should the nurse do to protect the client's swollen arm? Take the blood pressure only in the unaffected arm. Encourage a dependent position of the affected arm. Allow blood draws in the affected arm. Start an intravenous (IV) line in the affected arm.

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.

The nurse is explaining the long-term toxic effects of cancer treatments on the immune system to a client who is receiving chemotherapy and radiation therapy for colon cancer. What should the nurse tell the client? The helper T cells recover more rapidly than do the suppressor T cells, which results in a positive helper cell balance that can last 5 years. The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. Long-term immunologic effects have been studied only in clients with breast and lung cancer. Clients with persistent immunologic abnormalities after treatment are at a much greater risk for infection than clients with a history of splenectomy.

The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. Explanation: Studies of long-term immunologic effects in clients treated for leukemia, Hodgkin disease, and breast cancer reveal that combination treatments of chemotherapy and radiation can cause overall bone marrow suppression, decreased leukocyte counts, and profound immunosuppression. Persistent and severe immunologic impairment may follow radiation and chemotherapy (especially multiagent therapy). There is no evidence of a greater risk for infection in clients with persistent immunologic abnormalities. Suppressor T cells recover more rapidly than helper T cells.

A client is to have radiation therapy after a modified radical mastectomy. What instruction should the nurse give the client about caring for the skin at the site of the radiation therapy? Apply an ointment to the area. Expose the area to dry heat. Wash the area with water. Use talcum powder on the area.

Wash the area with water. Explanation: A client receiving radiation therapy should avoid lotions, ointments, and anything that may irritate the skin, such as exposure to sunlight, heat, or talcum powder. The area may safely be washed with water if it is done gently and care is taken not to injure the skin.

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include signs and symptoms of infection. expected chemotherapy-related adverse effects. reinforcement of the client's medication regimen. chemotherapy exposure and risk factors.

chemotherapy exposure and risk factors. Explanation: The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify the teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.

A client with supraglottic cancer undergoes a partial laryngectomy. Postoperatively, a cuffed tracheostomy tube is in place. When removing secretions that pool above the cuff, the nurse should instruct the client to take a deep breath as the nurse deflates the cuff. hold the breath as the cuff is being reinflated. cough as the cuff is being deflated. exhale deeply as the nurse reinflates the cuff.

cough as the cuff is being deflated. Explanation: The nurse should instruct the client to cough during cuff deflation. If the client can't cough, the nurse should perform suctioning to prevent aspiration of secretions. Because the cuff should be deflated during expiration, the client shouldn't take a deep breath as the nurse deflates the cuff. Likewise, because the cuff is reinflated during inspiration, the client shouldn't hold the breath or exhale deeply during reinflation.

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 perform breast self-examination annually. have a hormonal receptor assay annually. have a physician conduct a clinical examination every 2 years. have a mammogram annually.

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.

A young female client is receiving chemotherapy and mentions to the nurse that they and their spouse are using a diaphragm for birth control. Which information is most important for the nurse to discuss? transmission of sexually transmitted infections inconvenience of the diaphragm body changes related to hormones infection control

infection control Explanation: The risk for becoming neutropenic during chemotherapy is very high. Therefore, an inserted foreign object such as a diaphragm may be a nidus for infection. Although the nurse may wish to inform the client about the ease with which various contraceptive modalities may be used, the focus of this discussion should be on preventing an infection, which can be fatal for the neutropenic client. There are no data to suggest the client is at risk for acquiring a sexually transmitted disease. The client will not be experiencing body changes directly related to hormonal changes.

The client asks the nurse to explain what it means that Hodgkin disease is diagnosed at stage 1A. What should the nurse explain about the involvement of the disease? diffuse disease of one or more extralymphatic organs involvement of a single lymph node involvement of two or more lymph nodes on the same side of the diaphragm involvement of lymph node regions on both sides of the diaphragm

involvement of a single lymph node Explanation: In the staging process, the designations A and B signify that symptoms were or were not present when Hodgkin disease was found, respectively. The Roman numerals I through IV indicate the extent and location of involvement of the disease. Stage I indicates involvement of a single lymph node; stage II, two or more lymph nodes on the same side of the diaphragm; stage III, lymph node regions on both sides of the diaphragm; and stage IV, diffuse disease of one or more extralymphatic organs.

A woman tells the nurse, "There has been a lot of cancer in my family." The nurse should instruct the client to report which possible sign of cervical cancer? urinary and rectal symptoms leg edema light bleeding or watery vaginal discharge pain

light bleeding or watery vaginal discharge Explanation: In its early stages, cancer of the cervix is usually asymptomatic, which underscores the importance of regular Papanicolaou tests. A light bleeding or serosanguineous discharge may be apparent as the first noticeable symptom. Pain, leg edema, urinary and rectal symptoms, and weight loss are late signs of cervical cancer.

A client with a diagnosis of cancer is frequently disruptive and challenges the nurse. This behavior may be caused by which factor? the one-time crisis from learning of the diagnosis a history of a behavioral illness the usual trajectory of a short-term illness uncertainty and an underlying fear of recurrence

uncertainty and an underlying fear of recurrence Explanation: Clients with cancer report that the lifelong fear of recurrence is one of the most disruptive aspects of the disease. The trajectory of the disease is unpredictable and can be intertwined with many short- and long-term illnesses related to cancer and the treatment modalities. A diagnosis of cancer challenges the individual and the family with a series of crises rather than a time-limited episode. There are no data to indicate that the client has an underlying behavioral disorder.

The nurse is preparing a community presentation on oral cancer. Which is a primary risk factor for oral cancer that the nurse should emphasize in the presentation? frequent use of mouthwash use of alcohol lack of regular teeth cleaning by a dentist lack of vitamin B12

use of alcohol Explanation: Chronic and excessive use of alcohol can lead to oral cancer. Smoking and the use of smokeless tobacco are other significant risk factors. Additional risk factors include chronic irritation such as a broken tooth or ill-fitting dentures, poor dental hygiene, overexposure to the sun (lip cancer), and syphilis. Use of mouthwash, lack of vitamin B12, and lack of regular teeth cleaning appointments have not been implicated as primary risk factors for oral cancer.

After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when the nurse notes tidal movements or fluctuations in which compartment of the system as the client breathes? collection chamber air-leak chamber water-seal chamber suction control chamber

water-seal chamber Explanation: Fluctuations in the water-seal compartment are called tidal movements and indicate normal function of the system as the pressure in the tubing changes with the client's respirations. The air-leak meter — not chamber — detects air leaking from the pleural space. The collection chamber connects the chest tube from the client to the system. Drainage from the tube drains into and collects in a series of calibrated columns in this chamber. The suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest.

A nurse is assessing a client who is receiving the second administration of chemotherapy for breast cancer. When obtaining this client's health history, the nurse should ask the client which question? "Do you have your usual energy level?" "Has your hair been falling out in clumps?" "Have you been sleeping at night?" "Have you had nausea or vomiting?"

"Have you had nausea or vomiting?" Explanation: Chemotherapy agents typically cause nausea and vomiting when not controlled by antiemetic drugs. Antineoplastic drugs attack rapidly growing normal cells, such as in the gastrointestinal tract. These drugs also stimulate the vomiting center in the brain. Hair loss, loss of energy, and sleep are important aspects of the health history, but they are not as critical as the potential for dehydration and electrolyte imbalance caused by nausea and vomiting.

When the nurse is developing a plan of care to manage a client's pain from cancer, what should the nurse plan to do? Administer pain medication as soon as the client requests it. Select medications that are least likely to lead to addiction. Change pain medications periodically to avoid drug tolerance. Individualize the pain medication regimen for the client.

Individualize the pain medication regimen for the client. Explanation: The nurse should work with the client to individualize the plan of care for managing pain. Cancer pain is best managed with a combination of medications, and each client needs to be worked with individually to find the treatment regimen that works best. Cancer pain is commonly undertreated because of fear of addiction. The client who is in pain needs the appropriate level of analgesic and needs to be reassured that addiction is unlikely. Cancer pain is best treated with regularly scheduled doses of medication. Administering the medication only when the client asks for it will not lead to adequate pain control. As drug tolerance develops, the dosage of the medication can be increased.

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." "I removed all the throw rugs from the house." "I take a stool softener every morning." "I use an electric razor to shave."

"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 30-year-old client whose mother died of breast cancer at age 44 and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic? genetic counseling contacting the American Cancer Society (Canadian Cancer Society) mammogram Papanicolaou (Pap) testing every 6 months

genetic counseling Explanation: The nurse should suggest that the client ask the physician about genetic counseling. Genetic counseling is indicated for those at high risk because of family or personal cancer history. Genetic counseling involves obtaining a detailed medical and three-generational family history; calculating a personalized risk assessment; providing options for prevention, surveillance, and genetic testing; coordinating and interpreting genetic testing; and developing a management plan based on the test results. Mammography will assist with early detection of most breast cancers, but it won't establish a risk assessment and provide options for prevention, surveillance, and genetic testing. Pap testing every 6 months assists in early detection of most cervical cancers, but it won't establish a risk assessment. Contacting the American Cancer Society (Canadian Cancer Society) won't help assess the client's risk for developing cancer.

The nurse is teaching a client with abdominal cancer about taking medication to control the pain? What statement from the client indicates the need for additional teaching? "It's okay to take my pain medication even if I'm not having any pain." "I should skip doses periodically so I don't get hooked on my drugs." "I should take my medication around the clock to control my pain." "I should contact the oncology nurse if my pain isn't effectively controlled."

"I should skip doses periodically so I don't get hooked on my drugs." Explanation: The client should not skip dosages of pain medication to prevent addiction. Clients with cancer pain do not become psychologically dependent on the medication and should not fear becoming addicted. The nurse should allow the client and family members to verbalize their concerns about drug addiction.

The nurse is assessing a client who is suspected of being in the early symptomatic stages of human immunodeficiency virus (HIV) infection. Which indication of infection should the nurse detect during this stage? raised, hyperpigmented lesions on the legs bloody diarrhea dyspnea whitish-yellow patches in the mouth

whitish-yellow patches in the mouth Explanation: Oropharyngeal candidiasis, or thrush, is the most common infection associated with the early symptomatic stages of HIV infection. Thrush is characterized by whitish-yellow patches in the mouth. Various other opportunistic diseases can occur in clients with HIV infection, but they tend to occur later, after the diagnosis of acquired immunodeficiency syndrome has been made. Dyspnea can be indicative of pneumonia, which is caused by a variety of infective organisms. Bloody diarrhea is indicative of cytomegalovirus infection. Hyperpigmented lesions are indicators of Kaposi sarcoma.

The nurse is evaluating if a client with Hodgkin disease understands the monitoring that needs to be done at home between radiation treatments. Which statement would indicate that the client knows how to detect a major complication? "I will measure my neck circumference every day." "I will check the circulation in my arms every day." "I will take my temperature every day." "I will monitor the loss of body hair every week."

"I will take my temperature every day." Explanation: Clients with Hodgkin disease are extremely vulnerable to infection because of the defective immune responses caused by the tumor as well as the bone marrow depression and low white blood cell count that result from radiation therapy. Fever is the most sensitive indicator of infection and should be reported immediately so that treatment can be initiated.Measuring neck circumference is not related to any major complications associated with Hodgkin disease and radiation therapy.Loss of hair is unusual with radiation therapy to the neck.Upper extremity circulation is not related to any major complication associated with Hodgkin disease and radiation therapy.

A 70-year-old client asks the nurse if they need to have a mammogram. Which is the nurse's best response? "It will be sufficient if you perform breast examinations monthly." "Having a mammogram when you are older is less painful." "The incidence of breast cancer increases with age." "We need to consider your family history of breast cancer first."

"The incidence of breast cancer increases with age." Explanation: The nurse should explain that the incidence of breast cancer increases with age and current guidelines recommend women have a mammogram every 2 years until age 74. While mammograms are less painful as breast tissue becomes softer, the nurse should advise the woman to have the mammogram. Family history is important, but only about 5% of breast cancers are genetic. Several breast cancer screening guidelines recommend against breast self-examinations for women.

A client with stage IV pancreatic cancer is admitted to hospice. The spouse breaks down crying, stating "I just don't know what I will do if my partner dies!" What is the best response by the nurse? "I see you are upset. I will come back in 10 minutes and we can talk." "Your spouse has the best doctors and is receiving good care." "Do you want to speak with someone in the same situation?" "What has helped you cope with the illness so far?"

"What has helped you cope with the illness so far?" Explanation: The nurse needs to identify coping mechanisms in order to support the spouse. Peer support may be indicated but does not address the spouse's immediate statement nor does stating that the doctors are capable. The spouse should not be left alone before the nurse addresses the statement.

A client has just been diagnosed with cancer. During the initial stage of adaptation to the diagnosis and its treatment, the nurse can facilitate the client's adaptation by using which strategy? encouraging the client to maintain their usual role supporting the client in their use of denial as a coping strategy facilitating family-related disagreements and conflicts arranging transportation and childcare on treatment days

encouraging the client to maintain their usual role Explanation: Maintaining role function has been found to be a supportive source of normalcy and positive self-esteem for clients and their families during the cancer experience. Facilitating family-related disagreements and conflicts is not the nurse's role. Supporting the client in the use of denial as a coping strategy will not help facilitate the client's adaptation to the diagnosis. Arranging transportation and childcare on treatment days may be helpful but does not necessarily facilitate adaptation to the diagnosis.

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, the nurse prioritizes which nursing intervention? offering six small meals per day monitoring temperature and blood cell count allowing time for the client to talk about the condition providing frequent rest periods

monitoring temperature and blood cell count Explanation: Risk for infection takes highest priority in clients with severe bone marrow depression. This is because they have a decrease in the number of white blood cells, which are the cells that fight infection. Therefore, the nurse should monitor temperature and blood cell count. While the other interventions are helpful in the care of this client, the risk for infection takes precedence.

A client with a history of pancreatic cancer is revived following cardiac arrest but is determined to have suffered brain death. The family tells the nurse they want to donate any usable body organs so their loved one can live on in others. Which action by the nurse is appropriate? Check the driver's license for a donor sticker to authorize organ donation. Tell the family that the client is not a candidate for organ donation. Have the physician pronounce the client dead before taking the organs. Call the local organ procurement representative to meet with them.

Call the local organ procurement representative to meet with them. Explanation: An organ procurement organization representative is the best person to discuss organ donation with the family. Not all clients are candidates for organ donation for transplantation. People who have active cancer or systemic illnesses such as hepatitis or HIV cannot donate for transplantation, but their organs may be donated for research. The client and the organs will be evaluated by transplant specialists to determine the best use of the organs.

A client is taking doxorubicin and is distressed about hair loss. What should the nurse do? Have the client wash and massage their scalp daily to stimulate hair growth. Recommend that the client limit social contacts until hair regrows. Explain that hair loss is temporary and will quickly grow back to its original appearance. Provide resources for a wig selection before hair loss begins.

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 hairstyle 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 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 visual field deficits Related to impaired balance Related to psychomotor seizures Related to difficulty swallowing

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

The nurse is reviewing the lab report for a client in hospice care with breast cancer and brain metastasis. According to the information in the chart, what should the nurse do next? Document these results on the medical record. Refrain from reporting the results because the client is in hospice care. Report the elevated calcium level immediately. Report the elevated potassium level immediately.

Report the elevated calcium level immediately. Explanation: The normal calcium level is 9.0 to 10.5 mg/dL (2.25 to 2.63 mmol/L). Hypercalcemia is commonly seen with malignant disease and metastases. The other laboratory values are normal. Hypercalcemia can be treated with fluids, furosemide, or administration of calcitonin. Failure to treat hypercalcemia can cause muscle weakness, changes in level of consciousness, nausea, vomiting, abdominal pain, and dehydration. Although the client is on hospice care, she will still need palliative treatment. Comfort and risk reduction are components of hospice care.

Before surgery for a modified radical mastectomy, a client is extremely anxious and asks many questions. Which approach offers the best guide for the nurse to answer these questions? Tell the client as much as they want to know and can understand. Delay discussing the client's questions until their apprehension subsides. Explain to the client that they should discuss their questions first with the health care provider. Postpone discussing the client's questions until they are convalescing.

Tell the client as much as they want to know and can understand. Explanation: An important nursing responsibility is preoperative teaching, and the most frequently recommended guide for teaching is to tell the client as much as they want to know and can understand. Delaying discussion of issues about which the client has concerns is likely to aggravate the situation and cause the client to feel distrust. As a general guide, the client would not ask the question if they were not ready to discuss their situation. The nurse is available to answer the client's questions and concerns and should not delay discussing these with the client

A nurse is working with a dying client and the client's family. Which communication technique is most important to use? Avoid asking for more information from the client and family members. Use active listening and silence when communicating. Offer the family different coping mechanisms. Allow the family to initiate communication when they are ready.

Use active listening and silence when communicating. Explanation: When working with a dying client and the client's family, the nurse should use active listening and silence to assess their feelings, coping skills, and immediate and long-term needs. Active listening also helps the nurse select other appropriate strategies, such as reflection and clarification. Interpretation should be used sparingly to avoid making false inferences or putting the client or family on the defensive. Initiate the conversation whenever possible and assess the family and client's coping mechanisms, including what has worked for them in the past. If the nurse is uncertain how to respond, the nurse should ask for more information or clarification from the family not avoid speaking to them.

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? wearing a lead apron during direct contact with the client applying talcum powder to the irradiated areas daily after bathing removing thoracic skin markings after each radiation treatment avoiding using deodorant soap on the irradiated areas

avoiding using deodorant soap on the irradiated areas Explanation: Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water and a mild soap only and leave the area open to air. No deodorants 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.

The nurse is working at the local family planning clinic completing family education. When devising a teaching plan, in which client group would the nurse stress the importance of an annual Papanicolaou test? clients infected with the human papillomavirus (HPV) clients who were pregnant before age 20 clients with a long history of oral contraceptive use clients with a history of recurrent candidiasis

clients infected with the human papillomavirus (HPV) Explanation: Annual Papanicolaou testing is a screening to detect potential precancerous and cancerous cells in the endocervical canal of the female reproductive system. HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of oral contraceptives do not increase the risk of cervical cancer.

The nurse at the gynecologic clinic is teaching the client about the results of her Papanicolaou test, which demonstrated dysplasia. Which represents the nurse's best intervention? Ask the client about any family history of cervical cancer. Explain that the results show cervical changes that require follow up. Encourage the client to express feelings about cervical cancer. Assist the client to schedule a treatment plan for cervical cancer.

Explain that the results show cervical changes that require follow up. Explanation: Dysplasia, a precancerous condition, refers to an alteration in the size, shape, and organization of differentiated cells. The client will need further diagnostic evaluation to determine the scope of and treatment for the problem. Because the client does not have a diagnosis of cervical cancer, it is inappropriate to begin a treatment plan. Cervical cancer may run in families, but this is not the most important risk factor: infection with Human Papilloma Virus (HPV) and smoking are greater risk factors. Therefore, asking about family history is not the best intervention at this time. Encouraging the client to express feelings about cervical cancer is premature as the client is in a precancerous stage and requires follow up.

A client is to start chemotherapy to treat lung cancer. A venous access device has been placed to permit the administration of chemotherapeutic medications. Three days later at the scheduled appointment to receive chemotherapy, the nurse assesses that the client is dyspneic and their skin is warm and pale. The vital signs are blood pressure 80/30 mm Hg, pulse 132 bpm, respirations 28 breaths/min, temperature 103°F (39.4°C), and oxygen saturation 84%. The central line insertion site is inflamed. After the nurse calls the rapid response team, what should the nurse do next? Administer a prescribed antipyretic medication. Place cold, wet compresses on the client's head. Obtain a portable electrocardiogram monitor. Insert a peripheral intravenous fluid line and infuse normal saline.

Insert a peripheral intravenous fluid line and infuse normal saline. Explanation: The client is experiencing severe sepsis, and it is essential to increase circulating fluid volume to restore the blood pressure and cardiac output. Placing wet compresses, administering antipyretic medication, and monitoring the client's cardiac status may be beneficial for this client but are not the highest priority action at this time. These three interventions may require the nurse to leave the client, which is not advisable.

A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis? seizure disorder bleeding disorder anemia chronic obstructive pulmonary disease (COPD)

bleeding disorder Explanation: A bleeding disorder is a contraindication for thoracentesis because a hemorrhage may occur during or after this procedure, possibly causing death. Although a history of a seizure disorder, COPD, or anemia calls for caution, it doesn't contraindicate thoracentesis.

A female client is currently receiving radiation therapy to the chest wall for recurrent breast cancer. They have pain while swallowing and burning and tightness in their chest. The nurse should further assess the client for indications of which health problem? esophagitis stomatitis radiation enteritis hiatal hernia

esophagitis Explanation: Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy on the chest wall. Hiatal hernia is a herniation of a portion of the stomach into the esophagus. The client could experience burning and tightness in the chest secondary to a hiatal hernia, but not pain when swallowing. Also, a hiatal hernia is not a complication of radiation therapy. Stomatitis is an inflammation of the oral cavity characterized by pain, burning, and ulcerations. The client with stomatitis may experience pain with swallowing but not burning and tightness in the chest. Radiation enteritis is a disorder of the large and small bowel that occurs during or after radiation therapy to the abdomen, pelvis, or rectum. Nausea, vomiting, abdominal cramping, the frequent urge to have a bowel movement, and watery diarrhea are the signs and symptoms of radiation enteritis.

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem? a hemolytic allergic reaction caused by an antigen reaction a hemolytic reaction to mismatched blood a hemolytic reaction to Rh-incompatible blood a hemolytic reaction caused by bacterial contamination of donor blood

a hemolytic allergic reaction caused by an antigen reaction Explanation: Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhea, abdominal cramps and, possibly, shock.