RN 262 Cancer Colon/Lung cancer NCLEX ? Exam 2

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? a) The I.V. site is red and swollen. b) The client begins to shiver. c) The laboratory reports a white blood cell (WBC) count of 1,000/mm3. d) The client states he is nauseous.

a) The I.V. site is red and swollen

You are caring for a patient who is to begin receiving external radiation for a malignant tumor of the head and neck. While doing patient education, what side effects should the nurse discuss with the patient that should be assessed because of the radiation treatment? A) Impaired nutritional status B) Pink oral mucosa C) Diarrhea D) Alopecia

A Feedback: Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The patient is at an increased risk of impaired nutritional status. Option B is incorrect; the oral mucosa is normally pink. Options C and D are incorrect; diarrhea and alopecia are not concerns for this patient.

Adverse effects to chemotherapy are dealt with by patients and their caregivers every day. What would the nurse do to combat the most common adverse effects of chemotherapy? A) Administer an antiemetic B) Administer an antimetabolite C) Administer a tumor antibiotic D) Administer an anticoagulant

A Feedback: Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

While a patient is receiving intravenous doxorubicin hydrochloride, the nurse observes that there is swelling and pain at the IV site. The nurse should A) stop the administration of the drug immediately. B) notify the patient's physician. C) continue to administer but decrease the rate of infusion. D) apply a warm compress to the site.

A Feedback: Doxorubicin hydrochloride is a chemotherapeutic vessicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patient's physician. Ice can be applied to the site once the drug therapy has stopped.

You are the clinic nurse in an oncology clinic. Your patient arrives for a 2-month follow-up appointment following chemotherapy. You note that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A) Liver function test B) CBC C) Platelet count D) Electrolytes

A Feedback: Surveillance for cancer spread, recurrence, or second cancers: colonoscopy post colon cancer, mammography post breast cancer, Liver function tests post colon cancer, prostate-specific antigen post prostate cancer. Yellow skin is a sign of jaundice. The liver is a common organ affected by metastatic disease. A liver function test should be done to determine if the liver is functioning. Option B is incorrect; a CBC would show an altered white blood cell count indicating possible infection. Option C is incorrect; a platelet count tells whether the blood sample has an adequate number of platelets, necessary for blood clotting. Option D is incorrect; a blood test for electrolytes would not identify the cause of the jaundice.

What is the most important focus of hospice care? A) Focus of care is on the family as well as the patient. B) Focus of care is on the patient centrally and the family peripherally. C) Focus of care is solely on the patient. D) Focus of care emotionally is totally on the family.

A Feedback: The focus of hospice care is on the family as well as the patient. Therefore options B, C, and D are incorrect.

You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A) Palliative B) Reconstructive C) Salvage D) Prophylactic

A Feedback: When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote quality of life as defined by the patient and his or her family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.

The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient? A) "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and X-ray studies." B) "These symptoms are part of your disease and can't be helped." C) "Don't be concerned about these symptoms. Everybody feels this way after having radiation therapy." D) "This is a good sign. It means that only the cancer cells are dying."

A Feedback: Fatigue and weakness result from radiation treatment and usually don't represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and shouldn't be belittled. Radiation destroys both cancerous and normal cells.

You are a home health nurse caring for an oncology patient discharged home 3 days ago after completing therapy. What would you assess the patient for? A) Tumor lysis syndrome B) Syndrome of inappropriate antiduretic hormone C) Disseminated intravascular coagulation D) Hypercalcemia

A Feedback: Nursing care for tumor lysis syndrome: identify at-risk patients, including those in whom tumor lysis syndrome may develop up to 1 week after therapy has been completed. Institute essential preventive measures (eg, fluid hydration and allopurinol). Assess patients for signs and symptoms of electrolyte imbalances. Assess urine pH to confirm alkalization. Monitor serum electrolyte and uric acid levels for evidence of fluid volume overload secondary to aggressive hydration. Instruct patients to report symptoms indicating electrolyte disturbances. Options B, C, and D are incorrect.

You are caring for an oncology patient at risk for disseminated intravascular coagulation (DIC). What would be the appropriate care for this patient? (Mark all that apply.) A) Assist patient to turn, cough, and deep breathe B) Accurate I & O C) Prevent bleeding D) Assess hearing disturbances E) Maximize physical activity

A B C Feedback: Nursing care of the patient in DIC: Monitor vital signs. Measure and document intake and output. Assess skin color and temperature; lung, heart, and bowel sounds; level of consciousness; headache; visual disturbances; chest pain; decreased urine output; and abdominal tenderness. Inspect all body orifices, tube-insertion sites, incisions, and bodily excretions for bleeding. Review laboratory test results. Minimize physical activity to decrease injury risks and oxygen requirements. Prevent bleeding; apply pressure to all venipuncture sites, and avoid nonessential invasive procedures; provide electric rather than straight-edged razors; avoid tape on the skin and advise gentle but adequate oral hygiene. Assist the patient to turn, cough, and take deep breaths on a regular schedule. Reorient the patient, if needed; maintain a safe environment; and provide appropriate patient education and supportive measures. Option D is incorrect; hearing disturbances would be important to assess for.

You are the nurse caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What should you encourage the patient to do? (Mark all that apply.) A) Use a lip lubricant B) Scrub the tongue with a firm-bristled toothbrush C) Use dental floss every 24 hours D) Rinse the mouth with normal saline E) Eat hot foods to aid in killing the yeast

A C D Feedback: Stomatitis is an inflammation of the oral cavity. The patient should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.

8. A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite? A) High levels of alcohol consumption B) History of bowel obstruction C) History of diverticulitis D) Longstanding psychosocial stress

Ans: A Feedback: Risk factors include high alcohol intake; cigarette smoking; and high fat, high protein, low fiber diet. Diverticulitis, obstruction, and stress are not noted as risk factors for colorectal cancer.

The school health nurse is presenting a health-promotion class to a group of middle-school students. Which is the best intervention to address health-promotion strategies related to the leading cause of cancer deaths in North America? A) Monthly self-breast exams B) Smoking cessation C) Annual colonoscopies D) Monthly testicular exams

Ans: B Feedback: Cancer is second only to cardiovascular disease as a leading cause of death in the United States. Although the numbers of cancer deaths have decreased slightly, more than 560,000 Americans were expected to die from a malignant process in 2008. The leading causes of cancer death in the United States, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women, so smoking cessation is the health promotion initiative directly related to lung cancer. Therefore, the other options are incorrect.

18. A nurse caring for a patient with colorectal cancer is preparing the patient for upcoming surgery. The nurse administers cephalexin (Keflex) to the patient and explains what rationale? A) To treat any undiagnosed infections B) To reduce intestinal bacteria levels C) To reduce bowel motility D) To reduce abdominal distention postoperatively

Ans: B Feedback: Antibiotics such a kanamycin (Kantrex), neomycin (Mycifradin), and cephalexin (Keflex) are administered orally the day before surgery to reduce intestinal bacterial. Preoperative antibiotics are not given to treat undiagnosed infections, reduce motility, or prevent abdominal distention.

3. A patient has had an ileostomy created for the treatment of irritable bowel disease and the patient is now preparing for discharge. What should the patient be taught about changing this device in the home setting? A) Apply antibiotic ointment as ordered after cleaning the stoma. B) Apply a skin barrier to the peristomal skin prior to applying the pouch. C) Dispose of the clamp with each bag change. D) Cleanse the area surrounding the stoma with alcohol or chlorhexidine.

Ans: B Feedback: Guidelines for changing an ileostomy appliance are as follows. Skin should be washed with soap and water, and dried. A skin barrier should be applied to the peristomal skin prior to applying the pouch. Clamps are supplied one per box and should be reused with each bag change. Topical antibiotics are not utilized, but an anti fungal spray or powder may be used.

A patient with a diagnosis of colon cancer is 2 days postoperative following bowel resection and anastomosis. The nurse has planned the patients care in the knowledge of potential complications. What assessment should the nurse prioritize? A) Close monitoring of temperature B) Frequent abdominal auscultation C) Assessment of hemoglobin, hematocrit, and red blood cell levels D) Palpation of peripheral pulses and leg girth

Ans: B Feedback: After bowel surgery, it is important to frequently assess the abdomen, including bowel sounds and abdominal girth, to detect bowel obstruction. The resumption of bowel motility is a priority over each of the other listed assessments, even though each should be performed by the nurse.

28. A nurse is providing care for a patient whose recent colostomy has contributed to a nursing diagnosis of Disturbed Body Image Related to Colostomy. What intervention best addresses this diagnosis? A) Encourage the patient to conduct online research into colostomies. B) Engage the patient in the care of the ostomy to the extent that the patient is willing. C) Emphasize the fact that the colostomy was needed to alleviate a much more serious health problem. D) Emphasize the fact that the colostomy is temporary measure and is not permanent.

Ans: B Feedback: For some patients, becoming involved in the care of the ostomy helps to normalize it and enhance familiarity. Emphasizing the benefits of the intervention is unlikely to improve the patients body image, since the benefits are likely already known. Online research is not likely to enhance the patients body image and some ostomies are permanent.

20. A nurse caring for a patient with a newly created ileostomy assesses the patient and notes that the patient has had not ostomy output for the past 12 hours. The patient also complains of worsening nausea. What is the nurses priority action? A) Facilitate a referral to the woundostomy continence (WOC) nurse. B) Report signs and symptoms of obstruction to the physician. C) Encourage the patient to mobilize in order to enhance motility. D) Contact the physician and obtain a swab of the stoma for culture.

Ans: B Feedback: It is important to report nausea and abdominal distention, which may indicate intestinal obstruction. This requires prompt medical intervention. Referral to the WOC nurse is not an appropriate short term response, since medical treatment is necessary. Physical mobility will not normally resolve an obstruction. There is no need to collect a culture from the stoma, because infection is unrelated to this problem.

9. A patients screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this patients health problem? A) Adherence to a highfiber diet will help the polyps resolve. B) The patient should be assured that these are a normal, agerelated physiologic change. C) The patients polyps constitute a risk factor for cancer. D) The presence of polyps is associated with an increased risk of bowel obstruction.

Ans: C Feedback: Although most polyps do not develop into invasive neoplasms, they must be identified and followed closely. They are very common, but are not classified as a normal, age related physiologic change. Diet will not help them resolve and they do not typically lead to obstructions.

31. A patients colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the patient has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurses most appropriate response to this observation? A) Ensure that the patient knows that he or she will be responsible for care after discharge. B) Reassure the patient that many people are fearful after the creation of an ostomy. C) Acknowledge the patients reluctance and initiate discussion of the factors underlying it. D) Arrange for the patient to be seen by a social worker or spiritual advisor.

Ans: C Feedback: If the patient is reluctant to participate in ostomy care, the nurse should attempt to dialogue about this with the patient and explore the factors that underlie it. It is presumptive to assume that the patients behavior is motivated by fear. Assessment must precede referrals and emphasizing the patients responsibilities may or may not motivate the patient.

33. A nurse is assessing a patients stoma on postoperative day 3. The nurse notes that the stoma has a shiny appearance and a bright red color. How should the nurse best respond to this assessment finding? A) Irrigate the ostomy to clear a possible obstruction. B) Contact the primary care provider to report this finding. C) Document that the stoma appears healthy and well perfused. D) Document a nursing diagnosis of Impaired Skin Integrity.

Ans: C Feedback: A healthy, viable stoma should be shiny and pink to bright red. This finding does not indicate that the stoma is blocked or that skin integrity is compromised.

21. A nurse is working with a patient who is learning to care for a continent ileostomy (Kock pouch). Following the initial period of healing, the nurse is teaching the patient how to independently empty the ileostomy. The nurse should teach the patient to do which of the following actions? A) Aim to eventually empty the pouch every 90 minutes. B) Avoid emptying the pouch until it is visibly full. C) Insert the catheter approximately 5 cm into the pouch. D) Aspirate the contents of the pouch using a 60 mL piston syringe.

Ans: C Feedback: To empty a Kock pouch, the catheter is gently inserted approximately 5 cm to the point of the valve or nipple. The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. It is not appropriate to wait until the pouch is full, and this would not be visible. The contents of the pouch are not aspirated.

14. A nurse is talking with a patient who is scheduled to have a hemicolectomy with the creation of a colostomy. The patient admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. Which of the following nursing actions is most appropriate? A) Reassure the patient that the procedure is relatively low risk and that patients are usually successful in adjusting to an ostomy. B) Provide the patient with educational materials that match the patients learning style. C) Encourage the patient to write down these concerns and questions to bring forward to the surgeon. D) Maintain an open dialogue with the patient and facilitate a referral to the woundostomy continence (WOC) nurse.

Ans: D Feedback: A wound ostomy continence (WOC) nurse is a registered nurse who has received advanced education in an accredited program to care for patients with stomas. The enterostomal nurse therapist can assist with the selection of an appropriate stoma site, teach about stoma care, and provide emotional support. The surgeon is less likely to address the patients psychosocial and learning needs. Reassurance does not address the patients questions, and education may or may not alleviate anxiety.

19. A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer? A) Development of new hemorrhoids B) Abdominal bloating and flank pain C) Unexplained weight gain D) Change in bowel habits

Ans: D Feedback: The most common presenting symptom associated with colorectal cancer is a change in bowel habits. The passage of blood is the second most common symptom. Symptoms may also include unexplained anemia, anorexia, weight loss, and fatigue. Hemorrhoids and bloating are atypical.

Which of the following is the most plausible nursing diagnosis for a patient whose treatment for colon cancer has necessitated a colonostomy? A) Risk for Unstable Blood Glucose Due to Changes in Digestion and Absorption B) Unilateral Neglect Related to Decreased Physical Mobility C) Risk for Excess Fluid Volume Related to Dietary Changes and Changes In Absorption D) Ineffective Sexuality Patterns Related to Changes in SelfConcept

Ans: D Feedback: The presence of an ostomy frequently has an effect on sexuality; this should be addressed thoughtfully in nursing care. None of the other listed diagnoses reflects the physiologic changes that result from colorectal surgery.

A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment. The patient asks the nurse what the most common side effect of chemotherapy is. What would be the best answer the nurse could give? A) Alopecia B) Nausea and vomiting C) Altered glucose metabolism D) Increased appetite

B Feedback: Nausea and vomiting are the most common side effects of chemotherapy and may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these patients. Other side effects include bone marrow suppression, anorexia, vaginal dryness, and hair loss. Less common effects include altered glucose metabolism and jaundice.

The nursing instructor is discussing the difference between normal cells and cancer cells with the prenursing class in pathophysiology. What would the instructor cite as a characteristic of a cancer cell? A) Malignant cells contain more fibronectin. B) The cell membrane of malignant cells also contains proteins called tumor-specific antigens. C) Chromosomes are commonly found to be strong. D) Nuclei of cancer cells are large and regularly shaped.

B Feedback: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.

The nursing instructor is teaching a class in oncology nursing to her junior nursing students. The instructor is aware that infection is a significant consideration when providing care to an oncology patient. The leading cause of death in an oncology patient is infection caused by what? A) Malnutrition B) Impaired skin integrity C) Poor hygiene D) Broken oral mucosa

B Feedback: Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Option A is incorrect; malnutrition in oncology patients may be present, but it is not the leading cause of death. Option C is incorrect; oncology patients do not have poor hygiene at a rate any higher than other patients, and it does not cause death. Option D is incorrect; broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.

Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression? A) Decreased sodium levels and decreased potassium levels B) Increased creatinine and blood urea nitrogen (BUN) C) Decreased platelets and red blood cells D) Increased white blood cells and c-reactive protein (CRP

C

. Your patient has just returned from the PACU after salvage surgery for renal carcinoma. What would you assess this patient for? A) Vasoconstriction B) Anorexia C) Wound dehiscence D) Metastasis to the brain

C Feedback: Postoperatively, the nurse assesses the patient's responses to the surgery and monitors the patient for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. Options A, B, and D are incorrect. Vasoconstriction, anorexia, and metastasis to the brain are all things you would assess for even if your patient had not just returned from salvage surgery.

Traditionally, nurses have been involved with tertiary prevention with their cancer patients. However, emphasis is also placed on both primary and secondary prevention. What would be an example of primary prevention? A) Yearly Papanicolaou tests B) Testicular self-examination C) Teaching patients to wear sunscreen D) Screening mammogram

C Feedback: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Papanicolaou tests, mammograms, and testicular exams.

The nursing instructor is discussing the care of oncology patients with her junior nursing students. The instructor presents this scenario: An oncology patient develops erythema following radiation therapy. What should the nurse instruct the patient to do? A) Apply ice to the area. B) Keep the area cleanly shaven. C) Apply petroleum ointment to the affected area. D) Avoid using soap on the area of treatment.

D Feedback: Care to the affected area must focus on preventing further skin irritation, drying, and damage. Soaps, petroleum ointment, and shaving the area could worsen the erythema. Ice is also contraindicated.

You are orienting a new nurse to the oncology unit where you work. As you prepare to administer an antineoplastic agent to a one of your patients, what should you teach the new nurse about antineoplastic agents? A) Administer only prepackaged agents from the manufacturer B) Wash hands and arms following administration C) Use gloves and a lab coat D) Dispose of the antineoplastic wastes in the hazardous waste receptacle

D Feedback: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Option A is incorrect; you do not administer only prepackaged agents from the manufacturer. Option B is incorrect; this is a valid answer, but you wash your hands and arms before and after administering the medication.

You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes? Suck on hard candy during treatment. Encourage cheese and sandwiches. Stay away from protein beverages. Encourage maximum fluid intake.

b) Encourage cheese and sandwiches.

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? 1. Eat wholesome meals. 2. Avoid intake of fluids. 3. Avoid spicy and fatty foods. 4. Eat warm or hot foods.

c) Avoid spicy and fatty foods.

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? a) Check the client's history for a congenital link to thrombocytopenia. b) Perform a cardiovascular assessment every 4 hours. c) Closely observe the client's skin for petechiae and bruising. d) Monitor daily platelet counts.

c) Closely observe the client's skin for petechiae and bruising

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis. Encourage fluid intake to dilute the urine. Take measures to acidify the urine and prevent uric acid crystallization.

c) Encourage fluid intake to dilute the urine.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? a) Providing for frequent rest periods b) Placing the client in strict isolation c) Inspecting the skin for petechiae once every shift d) Administering aspirin if the temperature exceeds 102° F (38.8°)

c) Inspecting the skin for petechiae once every shift

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? a) "I use an electric razor to shave." b) "I take a stool softener every morning." c) "I removed all the throw rugs from the house." d) "I floss my teeth every morning."

d) "I floss my teeth every morning."

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? 1. Erythema 2. Flare 3. Extravasation 4. Thrombosis

extravasation