Cancer Practice
A postmenopausal client with cancer of the breast decides to have a lumpectomy followed by chemotherapy. After receiving chemotherapy for several weeks, she is not feeling well. The nurse reviews the medical record data presented in the image. After analysis of the available history, laboratory tests, and clinical manifestations, which goal has the highest priority for this client? A. Promote rest B. Prevent infection C. Avoid bodily harm D. Maintain fluid balance
B
Which response would the nurse use when a client, who receives radiation therapy for cancer, states, "My family said I will get radiation burn today" A. "Your skin blisters will look like you have a sunburn to the area" B. "A localized skin reaction usually occurs about 3 to 6 weeks after beginning treatment" C. "A daily application of an emollient will prevent a burn and soften the skin" D. "Your family must have had experience with radiation therapy several years ago"
B
A client is admitted for a biopsy of a tumor in her left breast. The client states, "I know it can't be cancer, because it doesn't hurt." Which response by the nurse is most therapeutic? A. "Let's hope that it isn't malignant." B. "What do you know about breast cancer?" C. "Most lumps in the breast are not malignant." D. "Has your primary health care provider told you that it wasn't cancer?"
B
When a client with acute myelocytic leukemia who is receiving chemotherapy develops tumor lysis syndrome, the nurse will anticipate a need to implement which collaborative action? A. Offer analgesics frequently B. Infuse large amounts of fluids C. Administer antibiotic therapy D. Give anticoagulant medication
B
Which intervention would the nurse include in the plan of care for a client with breast cancer who received doxorubicin and cyclophosphamide 12 days ago and now has a white blood cell (WBC) count of 1.4 cells/mm 3 and reports shortness of breath and activity intolerance? Select all that apply. One, some, or all responses may be correct. A. Use an electric razor when shaving B. Institute neutropenic precautions C. Place client on airborne precautions D. Transfuse two uses of packed red blood cells E. Instruct nursing staff to wear a dosimeter badge
B
Which skin growth would require health care provider follow-up to evaluate for possible skin cancer? Select all that apply. One, some, or all responses may be correct. A. Mole that is solid black B. Mole with equal borders C. Mole that is 12 mm wide D. Mole of symmetrical size E. Mole that has not changed
C
Allopurinol is prescribed for a child undergoing chemotherapy for cancer of the bone. When given the medication, the child asks, "Why do I have to take this pill?" Which response by the nurse is most appropriate? A. "It protects your body from getting new problems after your treatment is over." B. "It stops your sick white cells from going to other parts of your body." C. "The health care provider wouldn't prescribe anything for you unless it was important." D. "With the other medicines, it helps you get rid of the things that are making you sick."
D
Which instruction would the nurse provide a client receiving brachytherapy for prostate cancer to prevent injury? A. "Use bleach when doing laundry" B. "Wear a mask when around others" C. "Flush the toilet several times after use" D "Refrain from close contact with others"
D
A client is admitted with a diagnosis of stage 0 cervical cancer (carcinoma in situ). Which information about this diagnosis would the nurse emphasize while helping the client understand her diagnosis and prognosis? A. Five-year survival rates for this cancer are about 93%. B. Radiation therapy is as successful as surgery in the treatment of this type of cancer. C. Cancer has probably extended into the vaginal wall and may require a radical hysterectomy. D. Stage 0 indicates that the cancer is invasive and may require surgery in addition to radiation therapy.
A
A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which is the most appropriate initial nursing response? A. Encouraging expression of concerns B. Identifying the client's support systems C. Teaching stress reduction techniques D. Explaining that there are many effective cancer treatments
A
The nurse is performing a skin assessment of a client. Which findings may indicate a risk of skin cancer? Select all that apply. One, some, or all responses may be correct. A. Lesions B. Lumps C. Rashes D. Bruising E. Dryness
A, B, C
Which client activities warrant the highest priority for education about health promotion to prevent head and neck cancer? Select all that apply. One, some, or all responses may be correct. A. Chews tobacco B. Multiple sex partners C. Uses condoms when having sex D. History of alcohol abuse for 5 years E. Brushes with a soft-bristle toothbrush
A, B, D
A client admitted with a diagnosis of cervical cancer tells the nurse "I haven't had a Papanicolaou (Pap) smear for more than 8 years. I probably wouldn't be in the hospital today if I'd had those tests more often." Which response would the nurse provide? A. "Please tell me why you waited so long." B. "You feel as though you've neglected your health." C. "It's never too late to start taking care of yourself." D. "Most Individuals hate to have Pap smears done, but they're really important."
B
A client is hospitalized with a tentative diagnosis of pancreatic cancer. On admission the client asks the nurse, "Do you think I have anything serious, like cancer?" Which response by the nurse is most appropriate? A. "What makes you think you have cancer?" B. "I don't know if you do; let's talk about it." C. "Why don't you discuss this with your primary health care provider?" D. "You needn't worry now; we won't know the answer for a few days."
B
A client with multiple myeloma who is receiving the alkylating agent melphalan returns to the oncology clinic for a follow-up visit. For which adverse effect will the nurse monitor the client? A. Hirsutism B. Leukopenia C. Constipation D. Photosensitivity
B
A female client is diagnosed as having cancer of the breast and is admitted to the hospital for a lumpectomy to be followed by radiation. While being admitted to ambulatory surgery by the nurse, the client has tears in her eyes and her chin is quivering. In a shaky voice the client says, "I can't believe this is happening." Which is the best response by the nurse? A. "You can't believe this is happening/" B. "This must be a very scary time for you" C. "Do you have any questions at this time" D. "Cancer of the breast has a high cure rate"
B
Which discharge instruction would the nurse teach a client who receives a radium implant for uterine cervical cancer? A. "Limit your daily fluid intake" B. "Return for follow-up care" C. "Change to a high-residue diet" D. "Double the daily mineral supplements"
B
Which questions would the nurse ask to elicit psychosocial issues in a client with cancer? Select all that apply. One, some, or all responses may be correct. A. "Do you feel fatigue or restlessness?" B. "How is your family dealing with your condition?" C. "How do you rate your distress on a scale of 0 to 10?" D. "Have you noticed any problem with remembering things?" E. "Do you see yourself as a different person since you've had cancer?"
B, C, E
After recovery from a modified neck dissection for oropharyngeal cancer, the client receives external radiation to the operative site. Which side effect of radiation would the nurse expect to find? A. Dry mouth B. Skin reactions C. Mucosal edema D. Bone marrow suppression
C
The father of a child who is dying of cancer asks the nurse whether he should tell his 7-year-old son that his sister is dying. What is the most appropriate response by the nurse? A) "He can't comprehend the real meaning of death, so don't tell him until the last minute." B) "Your son probably fears separation most and wants to know that you will care for him, rather than what will happen to his sister." C) "You should talk this over with your health care provider, who probably knows best what's happening in terms of your daughter's prognosis." D) "Your son probably doesn't understand death as we do but fears it just the same. He should be told the truth to let him prepare for his sister's death."
D
The nurse manager in a cancer care facility finds that the nursing care team is lacking motivation as a result of consecutive deaths of 2 terminally ill clients. Which action of the nurse manager would help renew the team's energy? A. Counseling the team members that death is an inevitable part of chronic diseases B. Shifting the team to another nursing unit with less likelihood of deaths occurring C. Instructing the team members to be emotionally detached from the clients they care for D. Arranging a notice board in the unit and posting photos or messages reflecting achievements of the team
D
A complete blood count is prescribed before each round of a client's cancer chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? A. Platelets B. Hematocrit C. RBCs D. WBCs
D Looking for absolute neutrophil count under 1.5 is bad
To avoid complications in a client who has developed severe bone marrow depression after receiving chemotherapy for cancer, which actions by the nurse are appropriate? Select all that apply. One, some, or all responses may be correct. A. Monitor for signs of alopecia. B. Encourage an increase in fluids. C. Wash hands before entering the client's room. D. Advise use of a soft toothbrush for oral hygiene. E. Report an elevation in temperature immediately. F. Teach the client to avoid eating raw fruits or vegetables.
C, D, E
For which side effects will the nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply A. Diarrhea B. Leukocytosis C. Correct bleeding tendencies D. Lowered sedimentation rate E. Increased hemoglobin levels
A, B
Which vaccine would the nurse administer to provide protection from precancerous lesions and cancers of the vulva, cervix, and vagina in young girls and women? A. Rotavirus vaccine B. Varicella virus vaccine C. HPV vaccine D. Meningococcal conjugate vaccine
C
A farmer seeks medical care for a large crusty patch of skin on the cheek. The client states that even after using different remedies, it still bleeds easily and has not gotten better. From the client's history, the nurse suspects skin cancer. Which factor in the client's history helped the nurse form this conclusion? A. Exposure to radiation B. Location of the lesion C. Self-treatment of lesions D. Contact with soil contaminants
A
An adolescent girl is concerned about her body image after amputation of a leg for bone cancer. After the nurse has obtained the girl's consent, which action is most therapeutic? A. Encouraging her peers to visit B. Keeping her lower body covered C. Placing her in a room by herself D. Limiting her visitors to the family
A
An older adult client is diagnosed with cancer and fears death. Which nursing intervention would demonstrate caring? A. Touch B. Reminiscence C. Reality orientation D. Therapeutic communication
A
The primary health care provider instructs the nurse to manage fluid replacement therapy in a client with cancer. Which type of care is the client receiving? A. Palliative care B. Comfort care C. Supportive care D. End-of-life care
C
The spouse of a 22-year-old client who is being tested for Hodgkin lymphoma tells the nurse, "Don't you think it is unlikely for someone like my spouse to have cancer?" Which information about Hodgkin lymphoma will the nurse use when responding? A. More likely to affect women than men B. Diagnosed during adolescence and young adulthood C. Primarily a disease of older rather than younger adults D. More common among populations of Asian heritage
B
When a client who has seemed cheerful after a diagnosis of lung cancer and pneumonectomy becomes withdrawn after being discharged home, which action by the home health nurse will be best? A. Suggest that an antidepressant may be helpful. B. Ask the client to describe the current emotional state. C. Reassure the client that depression is a normal reaction. D. Ask the health care provider to make a mental health referral.
B
Which statement by the client indicates the need for further learning about skin cancer prevention? A. " I should use sunscreen before going outside" B. "I should limit sun exposure to between 7AM and 12 PM" C. "I should wear a hat and opaque clothing when going out" D. "I should have regular examinations of precancerous lesions"
B
The nurse reviews the medical record of a client with terminal cancer and notes the presence of a do-not-resuscitate (DNR) order. The order was written with the client's admission orders. The nurse recalls that which factor is relevant to the legal aspects of the DNR order? A. The policies of the agency establish the status of DNR orders. B. The age of the client is a primary factor in the decision not to resuscitate. C. Decisions regarding resuscitation reside with the client's primary health care provider. D. Once a DNR order is signed, it remains in force for the entire hospitalization.
A
An adolescent child is in the terminal stage of cancer. The parents ask how they will know when death is imminent. The nurse discusses the physical manifestations with the parents. Which are the signs and symptoms of approaching death? Select all that apply. One, some, or all responses may be correct. A. Decreased thirst B. Weak pulse C. Increased pulse rate D. Difficulty swallowing E. Loss of bladder control
A, B, D, E
An adolescent who is undergoing chemotherapy for the treatment of bone cancer has stomatitis as a result of chemotherapy. Which would the nurse include when teaching the child about self-care? Select all that apply. One, some, or all responses may be correct. A. Clean the teeth with a swab. B. Drink fluids through a straw. C. Brush the teeth three times a day. D. Rinse frequently with a mouthwash. E. Avoid foods served at extremes of temperature.
A, B, E
Which finding indicates that a client is at an increased risk for colorectal cancer (CRC)? Select all that apply. One, some, or all responses may be correct. A. Presence of dark, tarry stools B. Family history of polyposis C. 20-year history of ulcerative colitis D. Unintentional 20-pound weight loss E. Change in bowel pattern for 3 months
B, C, D, E
A client who is receiving radiation therapy for bone cancer lives alone and works full time. Which client action would the nurse encourage? A. Begin to perform regularly scheduled aerobic activity daily. B. Take a leave of absence from work when receiving therapy. C. Include rest periods during the day while receiving radiation. D. Continue the activities usually performed before becoming ill.
C
When a newly admitted client tells the nurse, "The doctor told me I have lung cancer. My father died from cancer. I wish I had never smoked," which response by the nurse is best? A. "What type of cancer did your father have?" B. "You are feeling guilty about your smoking" C. "you have been thinking about your diagnosis" D. "How many years have you smoked cigarettes?"
C
A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. Which explanation would the nurse give to explain the delay after surgery? A. Chemotherapy interferes with cell growth and delays wound healing. B. Because chemotherapy causes vomiting, it endangers the integrity of the incisional area. C. Chemotherapy decreases red blood cell production, and the resultant anemia will add to postoperative fatigue. D. Chemotherapy increases edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes.
A
An adolescent is admitted to the unit with a tentative diagnosis of a bone tumor of the left femur. During the admission procedure the adolescent casually asks, "Do they ever have to cut off a leg if someone has bone cancer?" How would the nurse respond? A. "Sometimes it's necessary. What do you think about that treatment?" B. "Most times the leg can be saved, but sometimes it may be necessary." C. "I don't understand why you're asking. Do you think that this will happen to you?" D. "The decision can't be made now, because the kind of bone cancer must be determined first."
A
A client with cancer of the bladder and pending surgical intervention asks, "If they remove my bladder, how will I be able to urinate?" Which response would the nurse use? A. "You can still function normally without a bladder" B. "I am sure this is very upsetting to you, but it will be over soon" C. "I know you're upset, but there are alternatives to removing your bladder" D. "The tests will help determine whether your bladder has to be removed"
C
The nurse teaches a client who is scheduled to receive intravenous chemotherapy for ovarian cancer about the use of imagery to maximize the effects of the chemotherapy and reduce the side effects. Which statement would the nurse use regarding this alternative therapy? A. "Rest your mind while remaining in the present" B. "Listen to soothing instrumental music during the infusion" C. "Light a candle with the scent of lavender during the infusion" D. "Focus on the droplets of chemotherapy attaching the cancer cells"
D
The spousal caregiver for a client receiving chemotherapy for inoperable bone cancer asks the nurse, "What can I do to help?" Which action best supports the client's spouse? A. Assist the couple to maintain open communication. B. Offer the couple a description of the disease process. C. Instruct the spouse about the action of the medications. D. Meet privately with the spouse to explore personal feelings
A
The nurse is collecting a health history from a client who has a diagnosis of cancer of the tongue. Which risk factor commonly associated with this type of cancer should the nurse assess when collecting the client's history? A. Nail biting B. Poor dental habits C. Frequent gum chewing D. Consuming a large amount of alcohol
D