ATI MedSurg - Oncology
A nurse is reinforcing preoperative teaching for a client who has colorectal cancer and is to undergo placement of a colostomy with a perineal wound. Which of the following statements by the client indicates an understanding of the teaching?
"I can have only liquids for 2 days before the surgery." - the client should consume a full or clear liquid diet for 24 to 48 hr before the surgery to decrease bulk. The client should consume a low-residue diet for several days prior to surgery to decrease peristalsis - following placement of a colostomy with a perineal wound, a rectal sensations such as pain and itching might occur even after healing of the client's surgical wound - the client should sit on foam pads or soft pillows and avoid the use of rubber donut devices because of the increased pressure to the incisional site - following surgery, the client's colostomy should begin to function withing 2 to 4 days
A nurse is reinforcing teaching to a client who has a cancer and is receiving external radiation therapy. Which of the following statements made by the client indicates an understanding of the teaching?
"I need to protect the area from sunlight." - to prevent skin irritation and subsequent breakdown, the nurse should instruct the client to protect areas of skin from sunlight - the nurse should instruct the client to avoid the application of skin lotion, as this might remove the radiation site markings. Additionally, the cream might be irritating to the skin or cause the client to have an allergic reaction - the nurse should instruct the client that massage can cause friction to the radiated skin, which might lead to skin breakdown - the nurse should instruct the client that external radiation sites are marked to indicate the exact area to receive the radiation therapy. Washing off the markings is contraindicated
A hospice nurse is reinforcing teaching about palliative care to the partner of a client who has end stage liver cancer. Which of the following statements by the partner indicates an understanding of teaching?
"I will continue to talk to him even when he's sleeping - the nurse should reinforce with the partner that hearing is though to be the last sense lost in the dying process; therefore, the partner should continue to softly communicate with the client - the nurse should reinforce to the partner that clients who are approaching death often refuse to nourishment and should not be forced to eat or drink - the nurse should reinforce to the partner that clients who are approaching death should be positioned with the head elevated or on the side - the nurse should reinforce to the partner that clients should be covered with a blanket to keep the extremities warm, not an electric blanket
A nurse is reinforcing discharge teaching to a client following open radical prostatectomy. The client is going home with an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching?
"I will take acetaminophen if I have any pain." - the nurse should teach the client to avoid aspirin and NSAIDs for at least 2 weeks following a surgery to prevent risk of bleeding - the nurse should instruct the clients to shower rather than take a tub bath for 2 to 3 weeks following an open radical prostatectomy - the nurse should instruct the client to use stool softeners, rather than suppositories, to control constipation - the nurse should inform the client that bladder control might not return immediately and practicing Kegel exercises can help with incontinence. Urinary incontinence can last for 1 to 2 years following surgery
A nurse is reinforcing a client who has breast cancer and is receiving a combination of chemotherapy medications. The client expresses confusion about the therapy. Which of the following explanations should the nurse provide?
"The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." - different chemotherapeutic agents act at various stages of cellular mitosis (division). By combining agents, medication therapy is more effective in stopping or slowing the growth of cancerous cells by interfering with their ability to multiply - a combination of chemotherapeutic agents does not lessen the incidence of renal toxicity - a combination of chemotherapeutic agents does not ensure a shorter duration of treatment - it is not entirely possible to eliminate the suppression of bone marrow caused by chemotherapeutic medications. The extent of bone marrow suppression is dependent on the specific medications being administered
A nurse is reinforcing postoperative teaching for a client following a panhysterectomy for uterine cancer. Which of the following information should the nurse provide?
"You might experience manifestations of menopause." - the nurse should inform the client that a panhysterectomy includes the removal of the uterus and ovaries, which might cause manifestations of menopause to occur. Manifestations of menopause include hot flashes, night sweats, and vaginal dryness - the nurse should inform the client that, following a panhysterectomy, pregnancy is not possible and birth control is no longer required - the nurse should inform the client to not lift anything heavier than 2.3 to 4.5 kg (5 to 10 lb) - the nurse should inform the client that pain or burning on urination is not an expected outcome of a panhysterectomy and to report these to the provider. Such manifestations can indicate a UTI
A nurse on an onclology unit is reinforcing discharge teaching for an adolescent client who received a bone marrow transplant for leukemia. Which of the following information should the nurse include? (SATA)
"You should take your temperature at least once a day." - Clients who are postoperative following bone marrow transplants are immunosuppressed and should continually monitor for manifestations of infection. A temperature that is greater than 38C (100F) should be reported immediately to the provider "Examine your feet daily." - a client who had a bone marrow transplant is immunosuppressed. The client should examine his feet daily to identify injuries that might increase the risk for infection - because of immunosuppression, the client should avoid crowds, such as those encountered at school, a mall, or a movie theater. They will also require time at home to recover and should limit their visitors to individuals who are healthy - client should not clean their toothbrush weekly with alcohol. Alcohol can cause trauma and irritation to the gums and tissues. Rinsing the toothbrush in a weak bleach solution or placing it in the dishwasher weekly are safer alternatives - fresh fruits and vegetables and as well as any other raw good can carry bacteria that may lead to an increased risk of infection
A nurse is admitting a client who has multiple myeloma and a white blood cell count of 2,000/mm3. Which of the following foods should the nurse prohibit the family members from bringing to the client?
a fresh fruit basket - raw fruits and vegetables are contraindicated for a client who has neutropenia, as the skin might harbor bacteria that can cause an infection. The nurse should prohibit these foods from entering the client's room - thoroughly cooked food products should not harbor bacteria that could be potential a source of infection for a client who has neutropenia - canned nutritional supplements are permissible for the client. Dispose of any amount leftover to prevent bacterial growth from contamination - a sealed box of candy should not harbor bacteria that could be a potential source of infection for a client who has neutropenia
A nurse is reinforcing discharge teaching to a client who is postoperative following a right mastectomy for breast cancer. The client will be going home with two Jackson-Pratt drains. Which of the following information should the nurse include in the teaching?
avoid wearing deordorant until the drains are removed and the incision heals - the nurse should instruct the client to avoid applying deodorants and talcum powder to the affected underarm until the drainage tubes are removed and incision is healed - the nurse should instruct the client that cloudy, malodorous drainage might indicate infection and should be reported to the provider - the nurse should instruct the client to take baths (no showers) until the provider removes the drainage tubes and stitches - the nurse should instruct the client that normal use and nonstrenuous exercise is appropriate before the provider removes the drainage tubes. More strenuous exercise can begin following the removal of the drains
A nurse is assisting in planning care for a client who is postoperative following a urinary diversion to treat bladder cancer. Which of the following interventions should the nurse include in the plan of care?
change the collection pouch in the early morning. - the nurse should plan to change the urinary collection pouch in the early morning when urine output is reduced - the nurse should empty the collection pouch when it is 1/3 full to half full to prevent the excess weight of the urine causing the pouch to separate from the skin - the nurse should expect no delay in urinary output following surgery. The nurse should monitor hourly urine output in the immediate postoperative period. Monitoring is then every 4 to 8 hr - the nurse should not use hydrogen peroxide to cleanse the skin around the stoma and under the collection pouch. The nurse should use soap and water for cleansing to decrease the risk of irritating the area
A nurse in an oncology clinic is collecting data from a client who has early stage Hodgkin's lymphoma. Which of the following findings should the nurse expect?
enlarged lymph nodes - Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver and bone marrow. The first manifestation of this cancer is often an enlarged painless lymph node, or nodes, which appear without a known cause. Other early manifestations include night sweats, unexplained weight loss, fever, and pruritus. The disease can spread to adjacent lymph nodes to the lungs, liver, bones or bone marrow. The spread of Hodgkin's lymphoma is usually in an ordered pattern - Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. Bone pain might be a late manifestation sign of metastasis. Bone and joint pain are early manifestations of leukemia and multiple myeloma, not Hodgkin's lymphoma - Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. Intermittent blood in the urine might be an indication of bladder cancer - A nonproductive cough might occur because of narrowed airways from swollen lymph glands. A productive cough might be an indication of lung cancer
A nurse is caring for a client who has lung cancer that has metastasized. Which of the following findings indicates the client is developing superior vena cava syndrome?
facial edema - superior vena cava syndrome is a medical emergency resulting from a partial occlusion of the superior vena cava, leading to a decreased blood flow through the vein. Most cases of superior vena cava syndrome are associated with cancers involving the client's upper chest, such as advanced lung and breast cancers and lymphoma. The earliest manifestations of superior vena cava syndrome are facial and upper extremity edema. Death can result if the compression is not corrected - superior vena cava syndrome is a partial occlusion of the superior vena cava. It leads to alterations in client's vascular flow, not cardiac arrhythmias - superior vena cava syndrome is a partial occlusion of the superior vena cava. Muscle cramps might inidcate the client has SIADH, and might occur with cancer metastasis to the brain - numbness of the client's hands is a manifestation of spinal cord compression that can result if cancer spreads to the spinal cord
A nurse is collecting data from a female client who is undergoing screening for breast cancer. Which of the following factors places the client at a high increased risk for developing breast cancer?
over 50 years of age - a female client whose age is over 50 years has a high increased risk for developing breast cancer - obesity places a client at a low but increased risk for developing breast cancer - oral contraceptive use places a client at a low but increased risk of developing breast cancer - the risk from alcohol use is dose dependent. Consumption of 3 to 14 drinks a week causes a slight risk for developing breast cancer
A nurse is collecting a health history from a client who has skin cancer. Which of the following findings in the client's history is the highest risk factor for developing skin cancer?
overexposure to sunlight - the nurse should identify the client's overexposure to sun as being the greatest risk factor for developing skin cancer - the nurse should recognize that a client being over the age 60 is a risk factor for skin cancer, however, there is a greater risk factor than age for developing skin cancer - the nurse should recognize that a client having a genetic predisposition is a risk factor for skin cancer. However, there is a greater risk factor for developing skin cancer - the nurse should recognize that a client being a light-skinned race is a risk factor for skin cancer, however, it is not the greatest risk factor
A nurse is caring for a client who is receiving chemotherapy to treat cancer. Which of the following adverse effects should the nurse anticipate from the chemotherapy?
pancytopenia - bone marrow suppression, a deficiency of WBCs, RBCs, and platelet counts, is an expected adverse effect of chemotherapy - gingival hyperplasia, or overgrowth of gingival tissue in the mouth, is caused by poor oral hygiene, leading to bacterial plaque and tartar accumulation. It is not an adverse effect of chemotherapy - hirsutism, or excessive body or facial hair, is generally caused by Cushing syndrome, especially in women. The nurse should expect to see alopecia, or hair loss, when the client receives chemotherapy - the client might have an inability or lack of desire to eat, causing weight loss due to the adverse effects of chemotherapy, such as a metallic taste in the mouth, nausea and vomiting
A nurse is assisting in planning care for a client who has cancer and has developed thrombocytopenia following chemotherapy. Which of the following precautions should the nurse offer to minimize the adverse effects of thrombocytopenia?
remind the client to use an electric razor - thrombocytopenia is a decrease in the client's blood platelet count, which places the client at an increased risk for bleeding due to the blood's inability to clot. Therefore, the nurse should institute bleeding precautions, which includes the use of an electric razor - the client has thrombocytopenia, not neutropenia. Neutropenia, a decreased WBC count, places a client at risk for infection prohibiting visitors who might be ill - the client does not need frequent rest periods because the client does not have iron-deficiency anemia. Iron-deficiency anemia necessitates the encouragement of frequent rest periods secondary to fatigue - stomatitis, an inflammation of the mucous membranes of the mouth, is not a manifestation of thrombocytopenia. The client who has stomatitis should use bland rinses and avoid commercial mouthwashes that contain alcohol, which might cause further breakdown to the oral tissue
A nurse is collecting data from a client who has cancer and is receiving chemotherapy by peripheral IV infusion. The client reports pain at the insertion site and the nurse notes fluid leaking around the catheter. Which of the following actions should the nurse take first?
stop the infusion - urgent vs. nonurgent priority-setting framework. Many chemotherapy medications are vesicants that can cause extensive tissue damage if extravasation occurs, therefore, the nurse's first action should be to stop the infusion immediately - the nurse should take a photograph of the IV site for documentation of potential harm from extravasation; however, there is another action that is priority - the nurse should take and record the client's vital signs following extravasation of a chemotherapy agent, however, there is another action that is priority - the nurse should identify all medications administered through the IV site for the past 24 hr, however, there is another action that is the priority
A nurse is collecting data from a client. Which of the following findings is the highest risk factor for the client developing bladder cancer?
the client who uses tobacco - the nurse should identify the client's tobacco use as being the greatest risk for developing bladder cancer - the nurse should recognize that exposure to chemicals, such as those used in hairdressing, is a risk factor for developing bladder cancer, however, there is a greater risk to the client than chemical exposure - the nurse should recognize that being over the age of 60 is a risk factor for developing bladder cancer, however, there is a greater risk to the client than age - the nurse should recognize that a history of UTIs is a risk factor for developing bladder cancer, however, this is not the greatest risk factor
A nurse is caring for a client who has testicular cancer and is experiencing peripheral neuropathy as an adverse effect of chemotherapy. Which of the following client manifestations is an expected finding of peripheral neuropathy?
tingling of the hands and feet - several chemotherapeutic agents might cause peripheral neuropathy. One of the major manifestations of peripheral neuropathy is numbness and tingling of an extremity - thinning of the scalp is alopecia, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy - reduced ability to concentrate reflects cognitive changes, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy - sores in the mucous membranes is mucositis, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy
A nurse is collecting data from a client who has cancer of the cervix. Which of the following manifestations should the nurse expect?
vaginal bleeding - the most common manifestation of cancer of the cervix is painless vaginal bleeding - unexplained weight loss is a manifestation of cervical cancer - dysuria is a manifestation of cervical cancer - pelvic and chest pain are manifestations of cervical cancer
