Oncology

A 52-year-old male was discharged from the hospital for cancer-related pain. His pain appeared to be well controlled on the IV morphine. He was switched to oral morphine when discharged 2 days ago. He now reports his pain as an 8 on a 10-point scale and wants the IV morphine. Which explanation is the most likely for the client's reports of inadequate pain control? He is addicted to the IV morphine. He is going through withdrawal from the IV opioid. He is undermedicated on the oral opioid. He is physically dependent on the IV morphine.

He is undermedicated on the oral opioid. Most clients with cancer who are experiencing inadequate pain control while taking an oral opioid after being switched from IV administration have been undermedicated. Equianalgesic conversions should be made to provide estimates of the equivalent dose needed for the same level of relief as provided by the IV dose. There is research to suggest that cancer clients do not become addicted to opioids when dosed adequately. There is no evidence to suggest that the client is physically addicted or is having withdrawal symptoms.

On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she: is lucky that the cancer was caught in time. should schedule a follow-up appointment in 6 months. should continue to perform breast self-examination on her right breast. will have irregular menses.

should continue to perform breast self-examination on her right breast. Having breast cancer on her left side puts the client more at risk for cancer on the opposite side and chest wall. Therefore, the nurse should stress the importance of monthly breast self-examinations and annual mammograms. Although the tumor was found, it was large enough to require a mastectomy, and could put the patient at risk for metastasis. Follow-up appointments should be monthly for the first few months and then scheduled at the direction of her health care provider. Modified radical mastectomy shouldn't affect the menstrual cycle.

A client is to have radiation therapy after a modified radical mastectomy. The nurse should teach the client to care for the skin at the site of therapy by: washing the area with water. using talcum powder on the area. applying an ointment to the area. exposing the area to dry heat.

washing the area with water. A client receiving radiation therapy should avoid lotions, ointments, and anything that may cause irritation to 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 if care is taken not to injure the skin.

Which statement indicates that the client needs further teaching about taking medication to control cancer pain? "It is okay to take my pain medication even if I am not having any pain." "I should contact the oncology nurse if my pain is not effectively controlled." "I should skip doses periodically so I do not get hooked on my drugs." "I should take my medication around-the-clock to control my pain."

"I should skip doses periodically so I do not get hooked on my drugs." The client should not skip his 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.

Several days before admission, a client reports finding a small lump in the left breast near the nipple. What should the nurse tell the client to do? Inform the physician immediately. Squeeze the nipple to check for drainage. Put a heating pad on the area to reduce inflammation. Check the area after the next menses.

Inform the physician immediately. The client should notify the physician immediately because a breast lump may be a sign of breast cancer. The client shouldn't squeeze the nipple to check for drainage until the physician examines the area. The client shouldn't wait until after the next menstrual period to inform the physician of the breast lump because prompt treatment may be necessary. Placing a heating pad on the area would have no effect on a breast lump.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? Liver Colon White blood cells (WBCs) Reproductive tract

Liver

A client with stage II ovarian cancer undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. During the second postoperative day, which assessment finding requires immediate intervention?

Shallow breathing and increasing lethargy Shallow breathing and a change in the level of consciousness, such as increasing lethargy requires immediate intervention because they may indicate a respiratory complication — for example, atelectasis or carbon dioxide retention. To avoid respiratory complications, the nurse should encourage turning, coughing, deep breathing, and ambulation during the early postoperative period. Abdominal pain, hypoactive bowel sounds, and serous drainage from the incision are expected findings during the first few days after this type of surgery.

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? Reports fatigue after sitting in the chair for 15 minutes Stage 3 pressure ulcer on the left heel Temperature of 99.8° F (37.6° C) White blood cell (WBC) count of 9000 cells/mm3

Stage 3 pressure ulcer on the left heel A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count is within normal limits. The temperature is slightly elevated, but not as relevant as the pressure ulcer. It is common to report fatigue while receiving chemotherapy.

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

The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. Studies of long-term immunologic effects in clients treated for leukemia, Hodgkin's 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 greater risk of infection in clients with persistent immunologic abnormalities. Suppressor T cells recover more rapidly than the helper T cells.

Lifestyle influences that are considered risk factors for colorectal cancer include:

a high-fat, low-fiber diet. A high-fat, low-fiber diet is a risk factor for colorectal cancer. A diet low in vitamin C, use of artificial sweeteners, and multiple sex partners are not considered risk factors for colorectal cancer.

A 3-year-old child receiving chemotherapy after surgery for a Wilms' tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would not be appropriate for this child? a milk shake fudge fresh strawberries french fries

fresh strawberries When a client receiving chemotherapy develops neutropenia, eating uncooked fruits and vegetables may pose a health risk due to possible bacterial contamination. All other foods are either cooked or pasteurized and would not produce a health risk.

A client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the right arm, and the client's left arm and hand should be elevated as much as possible to prevent: carpal tunnel syndrome. contractures. peripheral neuropathy. lymphedema.

lymphedema. Lymphedema is a common postoperative effect of modified radical mastectomy and lymph node dissection. Elevation of the left arm and hand will allow gravity to assist lymph drainage. Other preventive measures include exercises in which the arms are elevated. Peripheral neuropathy is not associated with postoperative complications, nor are contractures. Although muscle atrophy is a potential adverse effect if the client does not exercise her left arm, it would not be prevented by elevation

A client is receiving intravenous mannitol for treatment of a brain tumor. The client's intracranial pressure before administration of the mannitol was 14 mm Hg. Which assessment finding indicates that the medication is attaining a therapeutic effect?

Intracranial pressure of 10 mm Hg An expected finding with this osmotic diuretic is an intracranial pressure of 5-15 mm Hg. The medication is not administered to decrease agitation, lower systolic blood pressure, or decrease peripheral edema. The main therapeutic effect in brain tumor management is to decrease intracranial pressure.

A client receiving radiation to the head and neck is experiencing stomatitis. The nurse should recommend:

artificial saliva. Head and neck radiation can cause the complication of stomatitis and decreased salivary flow. A saliva substitute will assist with dryness, moistening food, and swallowing. Meticulous mouth care is needed; however, alcohol and vigorous brushing will increase irritation. Evaluation by a dentist to perform necessary dental work is done prior to initiation of therapy.

A client with bladder cancer has gross hematuria. The client's hemoglobin is 8.0 g/dL (80 g/L), and the health care provider (HCP) prescribes a unit of packed blood cells. The client has an existing intravenous infusion of normal saline using a 19-gauge needle. To administer the packed red blood cells, the nurse should: attach the packed cells to the existing 19G IV of normal saline solution using Y tubing. attach the packed blood cells to the existing 22G IV of 5% dextrose using Y tubing. start an additional 22G IV site because the packed blood cells must be given in a separate line. start an additional IV access device with a 22G intravenous cannulation device.

attach the packed cells to the existing 19G IV of normal saline solution using Y tubing.

A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would be most therapeutic for the client?

encouraging him to express his feelings nonverbally and in writing The client has undergone body changes and permanent loss of verbal communication. He may feel isolated and insecure. The nurse can encourage him to express his feelings and use this information to develop an appropriate plan of care. Discussing the client's behavior with his wife may not reveal his feelings. Exploring future plans is not appropriate at this time because more information about the client's behavior is needed before proceeding to this level. The nurse can respect the client's need for privacy while also encouraging him to express his feelings.

After a lobectomy for lung cancer, the nurse instructs the client to perform deep-breathing exercises to: elevate the diaphragm to enlarge the thorax so that the lung surface area available for gas exchange is increased. control the rate of air flow to the remaining lobe to decrease the risk of hyperinflation. expand the alveoli and increase lung surface available for ventilation. decrease blood flow to the lungs for rest and increased surface alveoli ventilation.

expand the alveoli and increase lung surface available for ventilation. Deep breathing helps prevent microatelectasis and pneumonitis and also helps force air and fluid out of the pleural space into the chest tubes. It does not decrease blood flow to the lungs or control the rate of air flow. The diaphragm is the major muscle of respiration; deep breathing causes it to descend, thereby increasing the ventilating surface.

A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her parents live 750 miles (1,200 km) away and have only been able to visit twice since her initial diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose chemotherapy. She is concerned about her children's welfare during the treatment. When assessing the client's present support systems, the nurse will be most concerned about the potential problems with: support systems and coping strategies. decision-making abilities. denial as a primary coping mechanism. transportation and money for the boys.

support systems and coping strategies. The client's resources for coping with the emotional and practical needs of herself and her family need to be assessed because usual coping strategies and support systems are often inadequate in especially stressful situations. The nurse may be concerned with the client's use of denial, decision-making abilities, and ability to pay for transportation; however, the client's support systems will be of more importance in this situation.

A client had a total abdominal hysterectomy and bilateral oophorectomy for ovarian carcinoma yesterday. She received 2 mg of morphine sulfate I.V. by patient-controlled analgesia (PCA) 10 minutes ago. The nurse was assisting her from the bed to a chair when the client felt dizzy and fell into the chair. The nurse should: take the client's blood pressure. administer oxygen. discontinue the PCA pump. assist the client back to bed.

take the client's blood pressure.

A client is to start chemotherapy to treat lung cancer. A venous access device has been placed to permit administration of chemotherapeutic medications. Three days later at the scheduled appointment to receive chemotherapy, the nurse assesses that the client is dyspneic and the 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 calling the rapid response team, what should the nurse do next? Place cold, wet compresses on the client's head. Administer a prescribed antipyretic. Insert a peripheral intravenous fluid line and infuse normal saline. Obtain a portable ECG monitor.

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

After surgery for gastric cancer, a client is scheduled to undergo radiation therapy. The nurse should include which information in the teaching plan? access to community resources management of alopecia exercise and activity levels nutritional intake

nutritional intake Clients who have had gastric surgery are prone to postoperative complications, such as dumping syndrome and postprandial hypoglycemia, which can affect nutritional intake. Vitamin absorption can also be an issue, depending on the extent of the gastric surgery. Radiation therapy to the upper gastrointestinal area also can affect nutritional intake by causing anorexia, nausea, and esophagitis. The client would not be expected to develop alopecia. Exercise and activity levels as well as access to community resources are important teaching areas, but nutritional intake is a priority need.

A client in the final stages of terminal cancer tells his nurse: "I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I continue my chemotherapy and radiation treatments only because my family wants me to." What is the nurse's best response? "Would you like to talk with your minister about the significance of death?" "Would you like to meet with your family and your physician about this matter?" "I know you are tired of fighting this illness, but death will come in due time." "Would you like to talk with a psychologist about your thoughts and feelings?"

"Would you like to meet with your family and your physician about this matter?" The nurse has a moral and professional responsibility to advocate for clients who experience decreased independence, loss of freedom of action, and interference with their ability to make autonomous choices. Coordinating a meeting between the physician and family members may give the client an opportunity to express his wishes and promote awareness of his feelings as well as influence future care decisions. Recommending a psychologist or minister and saying that death will come in due time are inappropriate responses.