oncology- passpoint

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 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. Remediation: Parenteral Nutrition Monitoring

A client seeks care for hoarseness that has lasted for 1 month. What is the most important question for the nurse to ask when assessing the client's health history? A. "Do you smoke cigarettes, cigars, or a pipe?" B. "Do you experience frequent heartburn?" C "How many alcoholic beverages do you drink each week?" D. "Have you strained your voice recently?"

Correct response: "Do you smoke cigarettes, cigars, or a pipe?" Explanation: Persistent hoarseness may signal throat cancer. Tobacco use is the most commonly associated risk factor for throat cancer. To assess the client's risk for throat cancer, the nurse would ask about smoking habits. Although straining the voice may cause hoarseness, it would not cause hoarseness lasting for 1 month. Frequent heartburn and increased alcohol consumption are risk factors associated with throat cancer, but the most important risk factor is smoking. Remediation: Tobacco Abuse Hoarseness

A nurse is assessing a woman 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? A. "Do you have your usual energy level?" B. "Has your hair been falling out in clumps?" C. "Have you had nausea or vomiting?" D. "Have you been sleeping at night?"

Correct response: "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 are not as critical as the potential for dehydration and electrolyte imbalance caused by nausea and vomiting. Remediation: Pre-Chemotherapy Assessment

A client has been informed of a diagnosis of cancer. Which client statement should the nurse address first? A. "I think the lab mixed up my biopsy with someone else's." B. "I need to end this before the cancer kills me." C. "I will beat this!" D. "I know I have cancer, but why me?"

Correct response: "I need to end this before the cancer kills me." Explanation: By making a statement such as "I need to end this," the client could be indicating a plan to commit suicide. The nurse should address this first. The other statements should be addressed second.

Which statement indicates that the client needs further teaching about taking medication to control cancer pain? "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." "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."

Correct response: "I should skip doses periodically so I don't get hooked on my drugs." Explanation: 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. Remediation: Pain Assessment

A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of possible lymphoma. Which statement made by the client demonstrates proper understanding of discharge teaching? Select all that apply. A. "I will take aspirin if I have pain." "B. I can apply an ice pack or a cold compress to the puncture site." C. "I do not need to inspect the puncture site." D. "I will not be able to play basketball for the next 2 days." E. "I will take acetaminophen for pain."

Correct response: "I will take acetaminophen for pain." "I will not be able to play basketball for the next 2 days." "I can apply an ice pack or a cold compress to the puncture site." Explanation: Acetaminophen is a safer analgesic than aspirin in order to avoid bleeding. Contact sports or trauma to the site should be avoided. Cool compresses should limit swelling and bruising. The puncture site should be inspected every 2 hours for bleeding or bruising during the first 24 hours. Remediation: Bone Marrow Aspiration Bone Marrow Aspiration

The nurse plans to teach a client who is receiving radiation therapy how to care for the skin at the radiation site. What should the nurse tell the client? A. "You may use deodorant soap if you wish to cleanse the area." B. "Apply a heating pad to the area to relieve pain." C. "Put baby oil on the area after each treatment to keep it from getting dry." D. "Keep the area covered when you go outdoors."

Correct response: "Keep the area covered when you go outdoors." Explanation: Radiated skin is sensitive to the sun and cold temperatures, so it should be protected.Heat should not be applied; the irradiated area should be protected from temperature extremes.Only mild soaps should be used.No lotions, perfumes, or oils should be applied to the area without the consent of the radiologist. Such preparations can increase the skin irritation that results from radiation treatments. Remediation: Radiation Skin Care

A 52-year-old client is scheduled for a total abdominal hysterectomy for cervical cancer. When discussing the potential impact of this procedure on the client's sexuality, how should the nurse respond to the client? A. "Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?" B. "All women experience sexual problems with this surgical procedure. Do you have any questions?" C. "Do you anticipate any problems with sex related to your scheduled hysterectomy?" D. "When can I schedule an appointment with you and your partner to discuss any issues either of you may have regarding sexuality?"

Correct response: "Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?" Explanation: This question introduces some basic information and allows for support for the client who may be experiencing some sexuality concerns. Not all women experience sexual problems after undergoing a hysterectomy. Assuming that the client will want to schedule an appointment with her partner is inappropriate and may embarrass her. Simply asking the client whether she expects to have problems with sex is too abrupt and does not provide any information. Remediation: Hysterectomy

The nurse explains to the client with Hodgkin's disease that a bone marrow biopsy will be taken after the aspiration. What should the nurse explain about the biopsy? A. "You may hear a crunch as the needle passes through the bone, but when the biopsy is taken, you will feel a suction-type pain that will last for just a moment." B. "You will be shaved and cleaned with an antiseptic agent, after which the primary care provider will inject a needle without making an incision to aspirate out the bone marrow." C. "You will feel a pressure sensation when the biopsy is taken but should not feel actual pain; if you do, tell the primary care provider so that you can be given extra numbing medicine." D. "Your biopsy will be performed before the aspiration because enough tissue may be obtained so that you won't have to go through the aspiration."

Correct response: "You will feel a pressure sensation when the biopsy is taken but should not feel actual pain; if you do, tell the primary care provider so that you can be given extra numbing medicine." Explanation: A biopsy needle is inserted through a separate incision in the anesthetized area. The client will feel a pressure sensation when the biopsy is taken but should not feel actual pain. The client should be instructed to inform the health care provider (HCP) if pain is felt so that more anesthetic agent can be administered to keep the client comfortable. The biopsy is performed after the aspiration and from a slightly different site so that the tissue is not disturbed by either test. The client will feel a suction-type pain for a moment when the aspiration is being performed, not the biopsy. A small incision is made for the biopsy to accommodate the larger-bore needle. This may require a stitch. Remediation: Bone Marrow Aspiration And Biopsy (Advanced Practice) Bone Marrow Biopsy

A client is ordered a dose of epoetin alfa to treat anemia related to chemotherapy. The recommended dose is 150 units/kg. The client weighs 60 kg. The vial is labeled 10,000 units/ml. How many milliliters of epoetin alfa would the nurse administer? Record your answer using one decimal place.

Correct response: 0.9 Explanation: First, determine the number of units of epoetin alfa the client is to receive:60 kg x 150 units/kg = 9,000 units.Next, determine the number of milliliters required to deliver that dose:10,000 units/1 ml = 9,000 units/XX = 9,000 units x 1 ml/10,000 units = 0.9 ml. Remediation: Calculating And Setting An IV Drip Rate

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

Correct response: 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. Remediation: Ovarian Cancer

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? A. Disturbed body image B. Chronic low self-esteem C. Anticipatory grieving D. Impaired swallowing

Correct response: 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 diagnosed with terminal lung cancer expresses a desire to seek spiritual advice. Which intervention by the nurse best provides spiritual support for this client? A. Identify the name of the spiritual advisor from the client's admission history. B. Ask if the client would like to speak to the nurse. C. Contact the most available spiritual advisor, even if of another faith. D. Ask who the client's spiritual advisor is and make the contact.

Correct response: Ask who the client's spiritual advisor is and make the contact. Explanation: The nurse may contact the client's spiritual advisor if the client so desires. The nurse can listen to the client, but spiritual support is best provided by someone proficient in that field, such as a spiritual advisor. It would be appropriate for the nurse to contact the clergy of another faith only if no other resources were available and if the client consented. The nurse should speak with the client and get the information firsthand, researching the admission history only if that is not possible. Remediation: Spiritual Care

A 32-year-old client with ovarian cancer is receiving hydroxyurea. Which finding indicates that the medication is having a therapeutic effect? A. Menses have stopped. B. White blood cell count is 2300 cells/mm3. C. Ca 125 level is decreasing. D. Nausea and vomiting have stopped.

Correct response: Ca 125 level is decreasing. Explanation: As cancer cells are destroyed, the Ca 125 level, a tumor marker, should decrease, indicating effective treatment. The client with ovarian cancer will require a hysterectomy and have surgical loss of menses. This is an antineoplastic medication rather than an antiemetic. Hydroxyurea may cause leukopenia, placing the client at risk for infection; it is a side effect rather than therapeutic effect. Remediation: Hydroxyurea

A nurse is caring for a client with a long-term central venous catheter. Which steps should the nurse include in teaching how to care for the catheter at home? A. If the needle becomes contaminated before accessing the port, clean the needle with povidone-iodine solution. B. Use clean technique when accessing the port with a needle. C. Flush each port using a 10ml NSS syringe, giving each port 5ml from the syringe. D. Clean the port with an alcohol pad before administering I.V. fluid through the catheter.

Correct response: Clean the port with an alcohol pad before administering I.V. fluid through the catheter. Explanation: Clients should be instructed to clean the port with an alcohol pad before administering I.V. fluid through the catheter to prevent microorganisms from entering the bloodstream. Using clean technique when accessing the port with a needle, cleaning the needle with a povidone-iodine solution, or flushing each port using the same syringe would break sterile technique. Remediation: Central Venous Catheter Central Venous Access Devices: Accessing An Implanted Port

A hospitalized client with end-stage heart failure does not want to be resuscitated. The health care provider (HCP) has written the do-not-resuscitate (DNR) prescription on the client's record. The client has a cardiac arrest, and the wife tells the nurse she wants the client to be resuscitated and asks the nurse to "do something." What should the nurse do? A. Page the HCP. B. Call a "code." C. Discuss the DNR prescription with the wife. D. Begin CPR.

Correct response: Discuss the DNR prescription with the wife. Explanation: The nurse must respect the wishes of the client who has indicated that he does not wish to be resuscitated and not to initiate CPR. Nurses who resuscitate clients who have directed otherwise may be considered to be battering the client. In this situation the HCP has written the DNR prescription, and it is not necessary for the nurse to page the HCP. The nurse can be most helpful by explaining the client's decision to the wife and helping her manage her understand her husband's wishes and manage her own grief. Remediation: Advance Directives

Following a simple mastectomy, the nurse is totaling the amount of drainage in 24 hours from a suction drain in the incision. The nurse notes there is 200 mL of serosanguineous drainage for the first 24 hours. What should the nurse do? A. Document the findings. B. Place the client's arm in a dependent position. C. Remove the drain. D. Notify the surgeon.

Correct response: Document the findings. Explanation: The nurse documents serosanguinous drainage of 100 to 200 mL because this is normal during the first 24 hours after surgery. The nurse notifies the surgeon only if there is excessive or very bloody drainage. The surgeon removes the drain within 24 to 48 hours. The client is instructed to keep her arm on the affected side and supported in an adducted position. Remediation: Mastectomy

Following a simple mastectomy, the nurse is totaling the amount of drainage in 24 hours from a suction drain in the incision. The nurse notes there is 200 mL of serosanguineous drainage for the first 24 hours. What should the nurse do? A. Document the findings. B. Remove the drain. C. Place the client's arm in a dependent position. D. Notify the surgeon.

Correct response: Document the findings. Explanation: The nurse documents serosanguinous drainage of 100 to 200 mL because this is normal during the first 24 hours after surgery. The nurse notifies the surgeon only if there is excessive or very bloody drainage. hoThe surgeon removes the drain within 24 to 48 Hours. The client is instructed to keep her arm on the affected side and supported in an adducted position. Remediation: Mastectomy

When the client who has had a modified radical mastectomy returns from the operating room to the recovery room, what should the nurse do first? A. Obtain and recording vital signs. B. Verify that drainage tubes are patent and functioning. C. Check the client's dressings for drainage. D. Ensure that the client's airway is free of obstruction.

Correct response: Ensure that the client's airway is free of obstruction. Explanation: The highest priority when a nurse receives a client from the operating room is to assess airway patency. If the airway is not clear, immediate steps should be taken so that the client is able to breathe.Vital signs can be assessed after airway patency is assured.Assessing the patency and functioning of drainage tubes can be done after the airway is assessed and vital signs are taken.The dressing can be assessed once airway patency has been determined. Remediation: Mastectomy

The client with a laryngectomy does not want to be observed by the family because the opening in the throat is "disgusting." How should the nurse respond to the client? A. Inform the client of the benefits of family support. B. Initiate teaching about the care of a stoma. C. Explore why the client believed the stoma is "disgusting." D. Explain that the stoma will not always look as it does now.

Correct response: Explore why the client believed the stoma is "disgusting." Explanation: Changes in body image are expected after a laryngectomy, and the nurse should first explore what is upsetting the client the most at this time. Many clients are concerned about how their family members will respond to the physical changes that have occurred as a result of a laryngectomy, but discussing the importance of family support is not helpful; instead, the nurse should allow the client to communicate any negative feelings or concerns that exist because of the surgery. The client's feelings are not related to a knowledge deficit, and therefore, it is too early to begin teaching about stoma care. It is also not helpful to offer reassurances about the change in appearance; the client will require time to adjust to the changed body image.

A client with suspected cervical cancer had a colposcopy with conization. What information should the nurse give the client about her menstrual periods after this surgery? A. Her next two or three periods will be lighter than normal. B. She may skip her next two periods. C. Her next two or three periods may be heavier and more prolonged than usual. D. Her periods will return to normal after 6 months.

Correct response: Her next two or three periods may be heavier and more prolonged than usual. Explanation: The client should be informed that her next two or three periods could be heavy and prolonged. The client is instructed to report any excessive bleeding. The nurse should reinforce the necessity for the follow-up check and the review of the biopsy results with the client. The client's periods will not be normal for 2 to 3 months. Remediation: Colposcopy

A client is newly diagnosed with cancer and is beginning a treatment plan. Which action by the nurse will be most effective in helping the client cope? A. Assume decision making for the client. B. Identify available resources for the client and family. C. Encourage strict compliance with all treatment regimens. D. Inform the client of all possible adverse treatment effects.

Correct response: Identify available resources for the client and family. Explanation: Identifying available resources for the client and family represents a respectful effort to make options available and encourages the client to become involved in treatment decisions. Assuming decision making for the client may foster dependence. Encouraging strict compliance with all treatment regimens may increase anxiety and limit the client's options and treatment choices. Informing the client of all possible adverse treatment effects may increase anxiety and fear by focusing on adverse outcomes too soon.

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

Correct response: 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. Remediation: Pain Management

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 the nurse calls the rapid response team, what should the nurse do next? A. Place cold, wet compresses on the client's head. B. Administer a prescribed antipyretic. C. Obtain a portable ECG monitor. D. Insert a peripheral intravenous fluid line and infuse normal saline.

Correct response: 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. 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. Remediation: Sepsis, Emergency Patient Care

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding? A. It calls for a repeat Pap test in 3 months. B. It's normal and requires no action. C. It calls for a biopsy as soon as possible. D. It calls for a repeat Pap test in 6 weeks.

Correct response: It calls for a biopsy as soon as possible. Explanation: A class V finding in a Pap test suggests probable cervical cancer; the client should have a biopsy as soon as possible. Only a class I finding, which is normal, requires no action. A class II finding, which indicates inflammation, calls for a repeat Pap test in 3 months. A class III finding, which indicates mild to moderate dysplasia, calls for a repeat Pap test in 6 weeks to 3 months. A class IV finding indicates possible cervical cancer; like a class V finding, it warrants a biopsy as soon as possible. Remediation: Papanicolaou (Pap) Test (Advanced Practice) PAP Test Cervical Cancer

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

Correct response: Notify the health care provider (HCP). Explanation: Nephrotoxicity caused by chemotherapy is assessed by monitoring serum creatinine. 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. Remediation: Melanoma (Malignant)

A nurse is accessing an implanted vascular access port. What action will the nurse take first in maintaining sterile technique? A. Perform hand hygiene. B. Clean the skin with a recommended skin preparation solution. C. Apply a sterile drape. D. Don sterile gloves.

Correct response: Perform hand hygiene. Explanation: Hand hygiene is the most effective way to prevent the spread of organisms. It is the first step in the practice of medical asepsis. Wearing sterile gloves is an important element of surgical asepsis, but it doesn't eliminate the need for hand hygiene. Applying skin preparation and sterile drapes are also key steps in surgical asepsis, but the first thing the nurse must always do is perform hand hygiene. Remediation: Implanted Port Access Donning And Removing Sterile Gloves Central Venous Access Devices: Accessing An Implanted Port

A physician performs a bone marrow aspiration from the posterior iliac crest on a client with a platelet count of 80,000 mm3. Which intervention should the nurse perform after the procedure? A. Maintain bed rest for 12-24 hours. B. Assist the client in using an incentive spirometer. C. Place pressure over the aspiration site for 5-10 minutes. D. Administer a vitamin K injection.

Correct response: Place pressure over the aspiration site for 5-10 minutes. Explanation: The client has a low platelet count and is at risk for bleeding. Maintaining pressure over the site for 5-10 minutes is required. Vitamin K is not given to prevent bleeding post procedure. Maintaining bed rest is not necessary. The use of an incentive spirometer is not warranted in this case. Remediation: Bone Marrow Aspiration And Biopsy (Advanced Practice) Bone Marrow Aspiration And Biopsy, Assisting Hemostasis

The nurse is caring for a client who will be undergoing a mastectomy. What would the nurse include in preoperative teaching? A. Teach about the Jackson-Pratt drain, pressure dressing, and deep-breathing exercises. B. Explain there will be minimal effects from anesthesia because the surgery is done so quickly. C. Inform the client that food or fluids will not be allowed for the first 2 days postoperatively. D. Explain that a small dressing will be placed on the chest and removed 12 hours postoperatively.

Correct response: Teach about the Jackson-Pratt drain, pressure dressing, and deep-breathing exercises. Explanation: Preoperative teaching related to what the client can expect after surgery is important. The nurse would include information regarding incision care and dressing, lines, drains, coughing and deep-breathing exercises (to prevent postoperative atelectasis), activity, and diet. The dressing would be a pressure dressing that will remain in place for at least 24 hours. The client will begin clear liquids as soon as tolerated postoperatively and the diet will progress as tolerated. Mastectomy is not superficial or quick; it requires general anesthesia, and the client may experience side effects as expected. Remediation: Mastectomy

A 56-year-old woman is admitted for a modified radical mastectomy. The client appears anxious and asks many questions. How should the nurse respond to this client? A. Tell the client as much as she wants to know and is able to understand. B. Delay discussing the client's questions with her until her apprehension subsides. C. Delay discussing the client's questions with her until the convalescent phase of her care. D. Explain to the client that she should discuss her questions with her health care provider (HCP).

Correct response: Tell the client as much as she wants to know and is able to understand. Explanation: An important nursing responsibility is preoperative teaching. The recommended guide for teaching is to tell the client as much as she wants to know and is able to understand. Delaying discussion of issues or concerns will most likely increase the client's anxiety. Telling the client to discuss questions with the HCP avoids acknowledging the client's concerns. Remediation: Mastectomy

A client with ovarian cancer asks the nurse, "What is the cause of this cancer?" Which is the most accurate response by the nurse? A. Use of oral contraceptives increases the risk of ovarian cancer. B. There is less chance of developing ovarian cancer when one lives in an industrialized country. C. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. D. Women who have had at least two live births are protected from ovarian cancer.

Correct response: The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. Explanation: A definitive cause of carcinoma of the ovary is unknown, and the disease is multifactorial. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. The highest incidence is in industrialized Western countries. Endocrine risk factors for ovarian cancer include women who are nulliparous. Use of oral contraceptives does not increase the risk for developing ovarian cancer, but may actually be protective. Remediation: Ovarian Cancer

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? A. Wear protective clothing. B. Reconstitute oral forms at the medication station. C. Dispose of intravenous (IV) tubing in the trash container . closest to the client. D. Wear a pair of sterile gloves when disconnecting intravenous (IV) tubing.

Correct response: Wear protective clothing. Explanation: A nurse must wear two layers of chemotherapy-approved disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. Reconstituted oral forms of chemotherapy, such as powders, should be prepared in the pharmacy and delivered in a sealed syringe. The nurse should use two layers of chemotherapy-approved gloves and a sterile gauze pad when priming IV tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or performing other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, IV tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container. Remediation: Chemotherapy Administration

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

Correct response: 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. Remediation: Radiation Skin Care

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? A. seizure disorder B. anemia C. bleeding disorder D. chronic obstructive pulmonary disease (COPD)

Correct response: 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. Remediation: Thoracentesis (Advanced Practice)

A 42-year-old female is interested in making dietary changes to reduce her risk of colon cancer. What dietary selections should the nurse suggest? A. oatmeal-raisin cookies, baked potato with sour cream, turkey sandwich B. bran muffin, skim milk, stir-fried broccoli C. granola, bagel with cream cheese, cauliflower salad D. croissant, granola and peanut butter squares, whole milk

Correct response: bran muffin, skim milk, stir-fried broccoli Explanation: High-fiber, low-fat diets are recommended to reduce the risk of colon cancer. Stir-frying, poaching, steaming, and broiling are all low-fat methods to prepare foods. Croissants are made of refined flour. They are also high in fat, as are peanut butter squares, whole milk, granola, cream cheese, and sour cream. Remediation: Colorectal Cancer

A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean? A. carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis B. no evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis C. can't assess tumor or regional lymph nodes and no evidence of metastasis D. carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis

Correct response: carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Explanation: TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.

Which outcome is expected of a nursing referral to a cancer support group? The client can: A. choose the best treatment options. B. find financial help. C. obtain home health care. D. cope with cancer.

Correct response: cope with cancer. Explanation: Support groups are designed to educate clients and their families experiencing cancer about the disease and methods of coping positively with it. These are self-help and support groups monitored by professionals and cancer survivors who have undergone a training course that helps them to facilitate small groups.

A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication? A. thrombosis B. flare C. erythema D. extravasation

Correct response: extravasation Explanation: The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system. Remediation: Chemotherapy Administration

Which nurse should be assigned to a client receiving brachytherapy for the treatment of cervical cancer? A. female nurse with 3 years' experience working in oncology B. male nurse who has floated to this unit from the operating room C. male nurse who is also assigned to another client receiving brachytherapy D. female nurse with 10 years' experience who suspects she may be pregnant

Correct response: female nurse with 3 years' experience working in oncology Explanation: Brachytherapy is internal radiation and nurses must use the principles of time, distance, and shielding. Radiation has cumulative effects and the nurse already working with a client receiving radiation should not be exposed to additional radiation. Working with clients who are receiving internal radiation takes a certain skill set, and the male nurse who has floated from the operating room is not the best person to work with this client. Radiation is harmful to the fetus, and the nurse who suspects she is pregnant should not be exposed to radiation. Remediation: Radiation Safety, Oncology

The nurse is performing a breast examination on a client. Which findings most strongly suggest that a client has breast cancer? A. swollen axilla lymph nodes, fever, and fatigue B. fixed nodular mass, breast pain, dimpling of the skin C. bloody discharge from nipple, multiple movable masses, pain D. asymmetry of breasts, clear discharge from nipple

Correct response: fixed nodular mass, breast pain, dimpling of the skin Explanation: A fixed nodular mass with dimpling of the overlying skin is the most significant sign of breast cancer. This is common during the late stages of breast cancer. Breast pain may be associated with cancer, but may also be related to a benign condition. Many women have asymmetrical breasts. Nipple discharge, whether bloody or clear, maybe a sign of cancer, but are also commonly associated with benign conditions and are not the most significant sign of cancer. Multiple firm, round, freely movable masses that change with the menstrual cycle indicate fibrocystic breasts, a benign condition. Although metastasis to lymph nodes may occur, fever is not a typical finding of breast cancer. Remediation: Breast Examination (Advanced Practice), Ambulatory Care Breast Cancer

A client had a right pneumonectomy for lung cancer yesterday and now has dyspnea. What position in bed will be best for this client? A. flat in bed on full bed rest B. head of bed elevated C. lying on the left side D. positioned for postural drainage

Correct response: head of bed elevated Explanation: The client will be most comfortable and have the best lung expansion with the head of the bed elevated. When in a side lying position, the client should lie on the right side to permit expansion of the unaffected lung. Postural drainage positioning will lower the head of bed and increase dyspnea. Lying flat will increase the dyspnea; the client should be encouraged to be out of bed as tolerated. Remediation: Lung Cancer

A client with cancer is uncertain about how to cope with all the issues that will arise. The nurse can best support the coping behaviors of a client with cancer by: A. helping the client identify available resources. B. assisting the client to prepare for adverse treatment effects. C. relieving the client of decision making as much as possible. D. encouraging compliance with treatment regimens.

Correct response: helping the client identify available resources. Explanation: Helping the client to identify available resources allows the client respect and time to make informed decisions and encourages the client to become actively involved with treatment options.Encouraging compliance with treatment regimens discourages the client from becoming actively involved in his treatment and diminishes coping ability.Relieving the client of decision making as much as possible is not appropriate and encourages feelings of helplessness and powerlessness.Assisting the client to prepare for adverse treatment effects may foster hopelessness and increase anxiety by focusing on adverse outcomes too soon.

A client, age 42, visits the gynecologist. After examining the client, the healthcare provider suspects cervical cancer. What will be most important for the nurse to include in assessing the client's health history? A. smoking history B. diet and exercise C. history of human papillomavirus infection D. the onset of sexual activity

Correct response: history of human papillomavirus infection Explanation: The nurse would assess for risk factors associated with cervical cancer. The most important risk factor for cervical cancer is human papillomavirus infection. The onset of sexual activity may indirectly increase the risk of cervical cancer. Smoking is a risk factor for cervical cancer but not the most important one. Diet and exercise are not important risk factors for cervical cancer. Remediation: Cervical Cancer

The nurse is teaching a client about risk factors for the development of colon cancer. What risk factor would the nurse include in the discussion? A. history of inflammatory bowel disease B. vegan eating pattern C. chronic constipation D. long-term use of laxatives

Correct response: history of inflammatory bowel disease Explanation: A history of inflammatory bowel disease is a risk factor for colon cancer. Other risk factors include age (older than 40 years), history of familial polyposis, colorectal polyps, and diet high in animal fat or red meat. Chronic constipaton and long-term use of laxatives are not among the risk factors. A vegan eating patter would include no meat or animal fats, and it would likely be high in fiber. Remediation: Colorectal Cancer

After a gastric cancer resection, a client is scheduled to undergo radiation therapy. What is the most important information the nurse should include in the discharge teaching plan? A. how to exercise to attain activity goals B. what do for alopecia C. how to maintain adequate nutrition D. where to access to community resources

Correct response: how to maintain adequate nutrition Explanation: 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. Remediation: Gastric Cancer Radiation, External

A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client? A. pain related to spontaneous bleeding episodes B. injury related to the decreased platelet count C. skin breakdown related to decreased tissue perfusion D. altered nutrition related to anemia

Correct response: injury related to the decreased platelet count Explanation: This client is at high risk for bleeding because of the decreased platelet count. The priority nursing goal is to prevent injury to this client by preventing bleeding occurrences. Spontaneous bleeding may cause pain but is not the priority. The client has a low platelet count, but not a low hemoglobin count such as exists in anemia. Skin integrity is a risk but not a priority. Remediation: Thrombocytopenia Management Thrombocytopenia, Long-Term Care

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

Correct response: 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's 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. Remediation: Hodgkin Lymphoma

A medication nurse is preparing to administer 0900 medications to a client with liver cancer. Which consideration is the nurse's highest priority? A. metabolism of the medication B. frequency of the medication C. necessity of the medication D. purpose of the medication

Correct response: metabolism of the medication Explanation: The rate and ability of the liver to metabolize medications will be altered in a client with liver cancer. Therefore, it is essential to understand how each medication is metabolized. The other considerations are important but not as vital. Remediation: Liver Cancer Liver Cancer

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous? A. eversion of the right nipple and mobile mass B. nonpalpable right axillary lymph nodes C. mobile mass that is soft and easily delineated D. nonmobile mass with irregular edges

Correct response: nonmobile mass with irregular edges Explanation: Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction — not eversion — may be a sign of cancer. Remediation: Breast Cancer

When explaining hospice care, what should the nurse should tell the client? "Hospice care: A. is coordinated by your health care provider." B. offers end-of-life care that includes palliative care and focuses on the client's physical, emotional, and spiritual needs." C. helps clients die at home." D. is available one month before treatment is no longer curative."

Correct response: offers end-of-life care that includes palliative care and focuses on the client's physical, emotional, and spiritual needs." Explanation: Hospice care services provide palliative care and also address the client's physical, emotional, and spiritual needs. The focus of the care is on the care on the client and family. Hospice care services can begin 6 months before the illness is terminal and can be renewed depending on the course of the disease. Hospice care collaborates with the client's health care provider (HCP), but the HCP does not direct the care. Not all hospice clients want to die at home, nor is it a requirement to be at home to receive hospice care. Remediation: Dying Patient Care

Which finding is an early indicator of bladder cancer? A. occasional polyuria B. dysuria C. nocturia D. painless hematuria

Correct response: painless hematuria Explanation: Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection. Remediation: Bladder Cancer

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

Correct response: 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. Remediation: Lung Cancer

A nurse is assessing a client and finds a crusted plaque on the client's forehead. The nurse suspects this is what type of skin cancer? A. dermatofibroma B. basal cell carcinoma C. squamous cell carcinoma D. malignant melanoma

Correct response: squamous cell carcinoma Explanation: Squamous cell carcinomas are malignant lesions that are generally found on areas of sun-damaged skin, especially the top of the head, neck, and lips. They can develop from normal skin or a preexisting lesion and typically present as crusted papules and plaques that may become indurated and ulcerated. Basal cell carcinomas are small, waxy nodules with translucent borders. Malignant melanoma is usually characterized by a flat, irregular border that may be tan, brown, or black. Dermatofibroma isn't a type of skin cancer; it is a benign, connective tissue tumor that is generally seen on the extremities. Remediation: Squamous Cell Carcinoma Of The Skin

A client undergoing chemotherapy has a white blood cell count of 2,300/mm3 (2.3 X 109/L); hemoglobin of 9.8 g/dL (98 g/L); platelet count of 80,000/mm3 (80 X 109/L); and potassium of 3.8. Which finding should take priority? A. temperature 101° F (38.3° C). B. emesis of 90 mL C. blood pressure 136/88 mm Hg D. urine output 40 mL/h

Correct response: temperature 101° F (38.3° C). Explanation: The client has a low white blood cell count from the chemotherapy and has a temperature. Signs and symptoms of infection may be diminished in a client receiving chemotherapy; therefore, the temperature elevation is significant. Early detection of the source of infection facilitates early intervention. Surveillance for bleeding is important with the low hemoglobin and platelet count; however, the high blood pressure does not indicate bleeding. Vomiting is a side effect of chemotherapy and should be treated. The urine output and potassium are within normal limits. Remediation: Neutropenia Management

The client with Hodgkin's disease undergoes an excisional cervical lymph node biopsy under local anesthesia. After the procedure, what does the nurse assess first? A. the incision B. vital signs C. the airway D. neurologic signs

Correct response: the airway Explanation: Assessing for an open airway is always first. The procedure involves the neck; the anesthesia may have affected the swallowing reflex, or the inflammation may have closed in on the airway, leading to ineffective air exchange. Once a patent airway is confirmed and an effective breathing pattern established, the circulation is checked. Vital signs and the incision are assessed as soon as possible, but only after it is established that the airway is patent and the client is breathing normally. A neurologic assessment is completed as soon as possible after other important assessments. Remediation: Lymph Node Biopsy

Which client is at highest risk for colorectal cancer? A. the client with a family history of lung cancer B. the client who follows a vegetarian diet C. the client who smoked 1 pack a day for 30 years D. the client who has been treated for Crohn's disease for 20 years

Correct response: the client who has been treated for Crohn's disease for 20 years Explanation: Clients over age 50 who have a history of inflammatory bowel disease are at risk for colon cancer. The client who smokes is at high risk for lung cancer. While the exact cause is not always known, other risk factors for colon cancer are a diet high in animal fats, including a large amount of red meat and fatty foods with low fiber, and the presence of colon cancer in a first-generation relative. Remediation: Colorectal Cancer

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/µl. What term should the nurse use to describe this low platelet count? A. thrombocytopenia B. leukopenia C. anemia D. neutropenia

Correct response: thrombocytopenia Explanation: A normal platelet count is 140,000 to 400,000/µl in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia). Neutropenia is the presence of an abnormally reduced number of neutrophils in the blood and is caused by bone marrow depression induced by chemotherapeutic agents. Remediation: Thrombocytopenia Management Thrombocytopenia

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

Correct response: 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. Remediation: Communication Fear

The nurse is encouraging an unlicensed assistive personnel (UAP) to interact with a dying client and family. The nurse should help the UAP understand that: A. when health care personnel do not understand their own feelings about death and dying, they often avoid the client. B. the dying person requires minimal physical care to be comfortable, and it is not necessary to provide daily care. C. the family members who are present can provide essential care. D. to protect a person's right to die with dignity, it is best to avoid interrupting the client.

Correct response: when health care personnel do not understand their own feelings about death and dying, they often avoid the client. Explanation: Health care personnel may avoid the terminally ill client because they are uncomfortable about death and do not understand their own feelings about dying. Family members should not be expected to assume responsibility for the client's care, but they should be involved in the client's care to the extent they desire. Skilled and knowledgeable nursing care is required to make a dying person comfortable. Interrupting the client does not necessarily interfere with the right to die with dignity.

For each client finding below, click to specify if the finding is consistent with the disease process of lymphedema, cellulitis, or compartment syndrome. Each finding may support more than 1 disease process. Assessment Findings Lymphedema Cellulitis Compartment Syndrome swelling erythema pain tingling reduced peripheral pulses loss of sensation

Explanation: Lymphedema, the swelling of an extremity because of reduced lymphatic drainage, is manifested by pain and tingling in the extremity. Skin in the area of cellulitis is red, swollen, and painful. Compartment syndrome (increased pressure in a confined space) causes pain, reduced distal pulses, tingling, edema, and loss of sensation. Remediation: Lymphedema Lymphedema Summary Explanation: A client comes to the outpatient clinic reporting a concern for swelling in the right arm. The client has a history of breast surgery due to cancer. Recognize the cues reported in the Nurses' Notes that are abnormal findings. Analyze the cues provided to determine which issue the client is entering the outpatient care clinic for. Determine or prioritize what is happening with the client and what the nurse would monitor for. Create an educational session for the client, and generate teaching content relevant to the client's condition and needs. Offer advice to the client on how to prevent complications and recognize early complications to report. Evaluate the outcomes for the client to determine if the client's condition has improved at the follow-up visit. The client has been discharged home from the follow-up visit.

For each potential intervention, click to specify whether the intervention is indicated, nonessential, or contraindicated for the client. Potential Interventions Indicated Nonessential Contraindicated exercise lymphatic massage dependent positioning of the right arm avoidance of nail polish weight loss

Explanation: Moderate exercise is beneficial in promoting lymphatic drainage and venous return. Lymphatic massage, performed by a specially trained therapist, promotes lymph contractility and movement of lymphatic fluids through a gentle massage technique. The right arm should be elevated to promote lymphatic drainage. Placing the arm in a dependent position, below the heart, promotes the accumulation of fluid. Because infection can promote edema, care should be taken to avoid creating a portal for infection; for example, the client should be advised to avoid cutting nail cuticles and to use repellents to avoid insect bites. Obesity is a risk factor for lymphedema, so the client should be advised to lose weight. There is no evidence suggesting that the use of nail polish increases the risk for lymphedema. Remediation: Lymphedema Lymphedema Summary Explanation: A client comes to the outpatient clinic reporting a concern for swelling in the right arm. The client has a history of breast surgery due to cancer. Recognize the cues reported in the Nurses' Notes that are abnormal findings. Analyze the cues provided to determine which issue the client is entering the outpatient care clinic for. Determine or prioritize what is happening with the client and what the nurse would monitor for. Create an educational session for the client, and generate teaching content relevant to the client's condition and needs. Offer advice to the client on how to prevent complications and recognize early complications to report. Evaluate the outcomes for the client to determine if the client's condition has improved at the follow-up visit. The client has been discharged home from the follow-up visit.

The nurse is educating the client on interventions to prevent and reduce lymphedema. Which advice would the nurse include? Select all that apply. A. Follow up with a specialist to be measured for a compression sleeve. B. At future medical appointments, use the right arm for blood pressure and venipuncture. C. Wear gloves while gardening. D. Avoid using sunscreen on the right arm. E. Apply a heating pad as needed for comfort. F. Seek medical attention if the skin becomes red or edematous. G. Avoid activities that can cause a break in the skin. H. Follow a well-balanced diet, and begin an exercise program.

Follow a well-balanced diet, and begin an exercise program. Follow up with a specialist to be measured for a compression sleeve. Avoid activities that can cause a break in the skin. Wear gloves while gardening. Seek medical attention if the skin becomes red or edematous. Explanation: Because obesity is a risk factor in the development of lymphedema, the client should be advised to lose weight through a healthy diet and exercise. A compression sleeve, measured and ordered from a specialist such as a physical therapist, should be worn to reduce movement of fluid out of capillaries and promote venous and lymphatic drainage. The right arm should not be used for blood pressure measurements or venipuncture to avoid interruption of blood flow and the risk for infection. A heating pad should not be applied to the right arm; it presents the risk for skin burns. Likewise, sunscreen should be used to avoid burns to the skin. The client should be advised to avoid activities that can cause breaks in the skin, providing a portal of entry for infection. For this reason, the client should wear gloves while gardening and should be taught the signs and symptoms of infection that require immediate medical attention. Remediation: Lymphedema Lymphedema Summary Explanation: A client comes to the outpatient clinic reporting a concern for swelling in the right arm. The client has a history of breast surgery due to cancer. Recognize the cues reported in the Nurses' Notes that are abnormal findings. Analyze the cues provided to determine which issue the client is entering the outpatient care clinic for. Determine or prioritize what is happening with the client and what the nurse would monitor for. Create an educational session for the client, and generate teaching content relevant to the client's condition and needs. Offer advice to the client on how to prevent complications and recognize early complications to report. Evaluate the outcomes for the client to determine if the client's condition has improved at the follow-up visit. The client has been discharged home from the follow-up visit.