Cancer (Presentation Questions) NRS210
The client diagnoses with lung cancer is being discharged. Which statement made by the client indicates that more teaching is needed? A. "It doesn't matter if I smoke now, I already have cancer." B. "I should see the oncologist at my scheduled appointment." C. "If I begin to run a fever I should notify the HCP." D. "I should plan for periods of rest throughout the day."
A, Research indicates that smoking will still interfere with the client's response to treatment.
The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse stresses that the most important preventive action for both men and women is: A. smoking cessation B. routine colonoscopies C. Protection from ultraviolet light. D. Regular examination of reproductive organs.
A, lung cancer is the leading cause of cancer deaths in the united states for both men and women, and smoking cessation is one of the most important cancer-prevention behaviors.
6.) The RN is administering intravenous chemotherapy to a client with cancer. Which of the following is NOT an appropriate technique? A.) Taping all IV tubing connections. B.) Wearing gloves when handling a patient's urine. C.) Disposing of chemotherapy as hazardous material. D.) Wearing a long-sleeved gown when administering chemotherapy.
A. According to OSHA and the Oncology Nursing Society, antineoplastic agents are administered using Luer-Lok fittings on all intravenous tubing to minimize the risk of exposure from needle stick injury. Additionally, nurses preparing and administering chemotherapy wear gloves and a disposable long-sleeved gown. Antineoplastic agents are disposed of as hazardous material and gloves are always worn when handling the excretions of clients who have received chemotherapy.
8.) During the IV administrations of a chemotherapeutic vesicant drug, the nurse observes that there is a lack of blood return from the intravenous catheter. Which of the following interventions does the nurse perform first? A.) Stop the administration of the drug. B.) Reposition the client's arm and continue with administration of the drug. C.) Irrigate the catheter with normal saline. D.) Continue to administer the drug and assess for edema at the IV site.
A. An intravenous catheter with no blood return is most likely occluded and not patent. Vesicant drugs force blood and lymph out of the vessels and into the surrounding skin tissue and causes necrosis of the tissue. The nurse should stop the drug immediately. Repositioning the arm doesn't improve patency. Irrigating the catheter may cause the medication to enter the tissue. Its inappropriate to wait to see if the arm because edematous because of the vesicant action of the drug.
When assessing a patient's needs for psychological support after the patient has been diagnosed with stage I lung cancer, which question by the nurse will provide the most information? A. "Can you tell me what has been helpful to you in the past when coping with stressful events?" B. "How long ago were you diagnosed with this cancer?" C. "Are you familiar with the stages of emotional adjustment to a diagnosis like lung cancer?" D. "How do you feel about having a possibly terminal illness?"
A: Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily.
. A patient who is undergoing abdominal surgery in two weeks asks the nurse about the use of acupuncture as a complementary modality for pain control. Which response from the nurse demonstrates her knowledge of the use of alternative therapies? A. Acupuncture has been studied and found to complement postoperative pain relief and reduce nausea and vomiting B. No study has shown any difference in postoperative course after receiving acupuncture C. Acupuncture is a relatively new procedure and has shown limited effects D. Acupuncture works best for smoking cessation and back pain
ANSWER: A Recent studied have shown a positive effect from acupuncture in relieving post-op pain when used in conjunction with traditional pain relief medications. One of the oldest, most commonly used medical procedures in the world, acupuncture is rapidly gaining acceptance in mainstream medicine in the United States.
) Radiation therapy is used to treat colon cancer before surgery for which of the following reasons? A. Reducing the size of the tumor B. Eliminating the malignant cells C. Curing the cancer D. Helping the bowel heal after surgery
Correct answer: A Rationale: Radiation therapy is used to treat colon cancer before surgery to reduce the size of the tumor, making it easier to be resected
An oncology client is admitted to the hospital with intractable pain. Many medications have been tried with no success. The oncology nurse is trained to provide clients with energy therapies. The nurse explains to the patient about the use of therapeutic touch. Which statement is true regarding this this therapy? A. Proponents of therapeutic touch believe that a strong desire to help the recipient is essential, as is a conscious use of self to act as a link between the universal life energy and the other person. B. Therapeutic touch is used for a wide variety of medical and nursing diagnosis but is best known for its use to relieve anxiety. C. Therapeutic touch practitioners place their hands on the specific problem areas and transfer energy from themselves to their clients to restore the balance of the client's energy fields. D.Therapeutic touch is a relatively newer idea and is grounded in the belief that hot and cold energy contain healing potential in oncology patients.
ANSWER: A The therapeutic touch practitioner, often a nurse, can modulate his or her energy field with that the client's directing it in a specific way to promote well-being and healing. Proponents of therapeutic touch believe that a strong desire to help the recipient is essential, as is a conscious use of self to act as a link between the universal life energy and the other person.
. A complementary and alternative therapy shown to be effective in treatment of a patient with chemotherapy-related nausea and vomiting is: A. Reiki B. Acupuncture C. Aromatherapy D. Magnetic therapy
ANSWER: B Clinical studies have indicated that acupuncture is clearly effective in treating adult postoperative and chemotherapy associated nausea and vomiting as well as postoperative dental pain. Reiki is an energy therapy used to heal disease, aromatherapy uses essential plant oils to promote and maintain overall health, and magnetic therapy is useful for relieving pain and promoting tissue healing.
Guided imagery, hypnosis, and therapeutic touch all share a common characteristic in how the therapeutic intervention is managed. This characteristic involves: A.Touch therapy B. Mind-body therapy C. Music therapy D. Mediation therapy
ANSWER: B Mind body therapies include progressive relaxation, biofeedback, prayer, humor, and laughter, hypnosis, therapeutic touch, and guided imagery.
The rehabilitation nurse is caring for an elderly patient who had a surgical repair of a fractured hip. The client states she misses her dog. Which intervention should the nurse implement? A. Put the television on a show with animal performers B. Arrange for the family to bring the client's dog for a visit C. Arrange for the client to have a visit from the pet therapy dog. D. Share the client's feelings are completely understood by the nurse.
ANSWER: B The client is in a rehab which often allows pet visits. Therefore, the nurse should investigate having the family bring the dog to the facility. This is being a client advocate.
The elderly client who wants to take an herbal supplement for arthritis symptoms should be advised to: A. Read labels very carefully prior to making a selection, because they are usually quite expensive. B. Consult their healthcare provider about possible interactions with current medications. C. Verify their effectiveness with friends or family members who have taken them. D. Reconsider the idea, because they might have serious side effects.
ANSWER: B Various herbal supplements may interact with certain medications. Nurses need to be aware of the various products available and provide education to patients to ensure safety with their use.
The nurse instructs a client taking clopidogrel (plavix) 75mg daily. Which of the following statements, if make by the client to the nurse, indicates understanding about the instructions? A. I will need to take a daily multivitamin pill every day while taking Plavix B. It will be necessary for me to have blood test monitoring done when take Plavix C. I will stop taking my garlic supplements while taking Plavix D. I can continue to take ibuprofen pills for my arthritis pain while taking Plavix
ANSWER: C Garlic has blood thinning properties. Too much garlic can increase your risk for bleeding during or after surgery. It may also interact with blood thinning medications.
The role of the nurse regarding complementary and alternative medicine (CAM) should include: A. Recommending herbal remedies that the client should use. B. Educating the client about "good" versus "bad" therapies. C. Discouraging the client from using any alternative therapies. D. Educating the client about therapies that he or she is using or is interested in using
ANSWER: D Complementary (alternative) therapies include a wide variety of treatment modalities that are used in addition to conventional therapy to treat a disease or illness. Educating the client about therapies that he or she uses or is interested in using the nurse's role.
The nurse is caring for a client in the rehab unit who is hearing impaired, is anxious, and has elevated blood pressure. The client enjoys pet therapy but is allergic to dogs and cats. Which intervention should the nurse implement? A. Administer antihistamine medication prior to pet therapy. B. Spend extra time visiting at the client's bedside. C. Arrange for a volunteer to bring the client a radio. D. Provide a colorful fish in a small bowl for the client
ANSWER: D For clients who have allergies to pet dander, the nurse can provide fish therapy. Studies indicate watching fish swim can decrease blood pressure and promote a calming effect.
Karen, a nurse educator asks a student to list the five categories of complementary and alternative medicine (CAM), developed by the National Center for Complementary and Alternative Medicine (NCCAM), to a group of nursing students. Which of the following, if stated by the nursing student, would indicate an understanding of the five categories of CAM? A. Herbology, hydrotherapy, acupuncture, nutrition, and chiropractic care B. Mind-body medicine, traditional Chinese medicine, homeopathy, naturopathy, and healing touch C. Biologically based practices, body-based practices, magnetic therapy, massage therapy, and Trager body work D. Whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine
ANSWER: D The five categories of complementary and alternative medicine (CAM) include whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine. The other options contain therapies within each category of CAM
1. For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client? a. "Client verbalizes feelings of anxiety." b. "Client doesn't guess at prognosis." c. "Client uses any effective method to reduce tension." d. "Client stops seeking information."
Answer A. Verbalizing feelings is the client's first step in coping with the situational crisis. It also helps the health care team gain insight into the client's feelings, helping guide psychosocial care. Option B is inappropriate because suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly. Option C is undesirable because some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client from coming to terms with the threat of death as well as cause physiologic harm. Option D isn't appropriate because seeking information can help a client with cancer gain a sense of control over the crisis.
4. A 34-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client? a. She should have had a baseline mammogram before age 30. b. She should eat a low-fat diet to further decrease her risk of breast cancer. c. She should perform breast self-examination during the first 5 days of each menstrual cycle. d. When she begins having yearly mammograms, breast self-examinations will no longer be necessary.
Answer B. A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman's risk of breast cancer. A baseline mammogram should be done between ages 30 and 40. Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms.
5. The RN is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? a. Pain at the incisional site b. Arm edema on the operative side c. Sanguineous drainage in the Jackson-Pratt drain d. Complaints of decreased sensation near the operative site
Answer B. Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options A, C, and D are expected occurrences following mastectomy and do not indicate a complication.
9. Which of these findings in the breast of a patient who is suspected of having breast cancer would support the diagnosis? a. complaints of dull, achy, pain b. palpation of a mobile mass c. presence of an inverted nipple d. area of discoloration skin
Answer C. Inversion of nipple is one of the manifestations of breast cancer. A cancerous lesion is non-mobile.
6. The night shift nurse notes at the end of her shift that a client who had a mastectomy has a total of 90mL of serosanguineous drainage after a 24-hour period. What is the best nursing action? a. Report amount of drainage to the physician b. Start frequent blood pressure checks and observe for hemorrhage c. Continue to monitor the drainage d. Reinforce packing at the wound site
Answer C. Up to 100mL of serosanguineous fluid would be an acceptable amount of drainage over a 24-hour period in a client who has had a mastectomy. There is no indication of hemorrhage or the need to perform frequent BP checks. If the nurse observes a greater amount of fluid in the drains, then it would be important to notify the physician.
2. The RN is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: a. breast self-examination. b. mammography. c. fine needle aspiration. d. chest X-ray.
Answer C. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.
3. The RN is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover: a. cancerous lumps. b. areas of thickness or fullness. c. changes from previous self-examinations. d. fibrocystic masses.
Answer C. Women are instructed to examine themselves to discover changes that have occurred in the breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed to malignant.
7. A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy? a. Urine output of 400 ml in 8 hours b. Serum potassium level of 3.6 mEq/L c. Blood pressure of 120/64 to 130/72 mm Hg d. Dry oral mucous membranes and cracked lips
Answer D. Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.
8. The nurse is caring for a client who has had a mastectomy. What is important nursing care regarding the positioning of the affected arm? a. Hold the arm close against the side of the body b. Secure the arm below the level of the heart c. Wrap the arm in an Ace bandage and keep it below the heart d. Elevate arm above heart level
Answer D. Elevating the affected arm promotes drainage of lymph from the extremity and decreases fluid from the wound site, which reduces swelling. An elastic wrap may be applied to the affected arm to reduce swelling, but it would not be positioned below the heart level.
10. The RN is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination: a. at the end of her menstrual cycle. b. on the same day each month. c. on the 1st day of the menstrual cycle. d. immediately after her menstrual period.
Answer D. Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman's breasts are still very tender. Postmenopausal women because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.
1. The client in the gynecology clinic asks the nurse "What are the risk factors for developing cancer of the cervix?" What statement is the nurse's best response? A. "The earlier the age of sexual activity and the more partners, the greater the risk" B. "Eating fast foods high in fat and taking birth control pills are risk factors" C. A Chlamyida trachomatis infection can cause cancer of the cervix" D. "Having yearly Pap smears will protect you from developing cancer.
Answer: A Rationale: Risk factors for cervical cancer include: sexual activity before the age of 20, multiple sexual partners; early child bearings; exposing HPV, HIV infection and Vitamin C deficiency.
4. A client with a diagnosis of HPV is at risk for which of the following? A. Hodgkin's lymphoma B. Cervical cancer C. Multiple myeloma D. Ovarian cancer
Answer: B Rational: The client with HPV is at higher risk for cervical and vaginal cancer.
3. A nurse is educating a group of women at a community center about the importance of being screened for cervical cancer. Which of the following clients is most at risk for cervical cancer? A. A 40 year old Caucasian woman who has one sexual partner, her husband, her entire life. B. A 38 year old African American woman who has a history of human papillomavirus (HPV). C. A 26 year old Asian woman who had her first sexual encounter at 15 years old. D. A 55 year old Hispanic woman who has tested negative for HPV.
Answer: B Rationale: Risk factors for cervical cancer include infection of the external genitalia and anus with HPV, first intercourse before 16 years of age, multiple sex partners or male partners with multiple sex partners, a history of sexually transmitted infections, and infection with HIV. The most important risk factor is infection by the HPV. Other risk factors include smoking and poor nutritional status, family history of cervical cancer, and exposure to DES (diethylstilbestrol) in utero. The incidence is greater in black women than in white women. # 2 is the correct answer because the client is African American and has had HPV in the past. This puts her at greatest risk.
5. When planning care for a client being treated for cervical cancer, it would be a priority for the nurse to include which of the following in the plan of care? A. Instruction on birth control methods B. Vigorous fluid hydration C. Assessment of sexual function D. Daily weights
Answer: C Rationale: Surgery and radiation therapy for cervical cancer often results in shortening of the vagina, vaginal dryness, and loss of libido due to emotional issues related to sexuality and femininity. Therefore, the client's feelings about sexuality and the partner's feelings should be assessed. If a client is not sexually active, instructions should be given in the use of a vaginal dilator and lubricant to prevent adhesion of the vaginal walls. While instruction about birth control methods may be needed for some clients, treatment for cervical cancer may include total abdominal hysterectomy, so that this would not be appropriate for all clients. Encouraging fluids and daily weights are not priorities in cervical cancer care.
The postmenopausal client reveals it has been several years since her last gynecological examination and states, "Oh, I don't need exams anymore. I am beyond having children." Which statement should be the nurse's response? A. "As long as you are not sexually active, you don't have to worry" B. "You should be taking hormone replacement therapy now" C. "You are beyond bearing children. How does that make you feel?" D. "There are situations other than pregnancy that should be checked."
Answer: D Rationale: A client should have a yearly clinical exam of the breasts and the pelvic area for detection of cancer.
7. The client is diagnosed with early cancer of the prostate. Which assessment data would the client report? A. Urinary urgency and frequency. B. Retrograde ejaculation during intercourse. C. Low back and hip pain D. No problems have been noticed.
Answer: D Rationale: In the EARLY stages of prostate cancer- the man will not be aware of the disease. Early detection is achieved by screening for cancer. NOT- Choice A and C are late signs of prostate cancer, choice B is involving male infertility.
4.) Chemotherapeutic agents have which effect associated with the renal system? A.) Hypokalemia. B.) Increased uric acid excretion. C.) Hypophosphatemia. D.) Hypercalcemia.
B. Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. There is increased urinary excretion of uric acid from chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.
10.) Which of the following nursing diagnosis would rank as the most important in the planning of care for a client in two weeks after the chemotherapy has begun? A.) Activity intolerance. B.) Potential for infection. C.) Self-esteem disturbance. D.) Impaired skin integrity.
B. Chemotherapy causes immunosuppression. Therefore, the patient is at risk for developing an infection.
A patient says to the nurse "I have lung cancer. What's the point in using an incentive spirometer?" The best answer that the nurse can give would be: A. "The incentive spirometer will cure your lung cancer." B. "The incentive spirometer works by breathing for you." C. "The incentive spirometer allows you to improve lung functioning by taking in deep breaths to fill your lungs." D. "The incentive spirometer prevents bronchiolar collapse through deep, sustained exhalation."
C. The incentive spirometer does not cure lung cancer, and giving that response would instill the patient with false hope. Choice B is describing mechanical ventilation. Choice D is describing pursed-lip breathing. Choice C correctly describes the purpose of an incentive spirometer.
1.) When teaching the patient with cancer about chemotherapy, the nurse should A.) Avoid telling the patient about possible side effects of drugs to prevent anticipatory anxiety. B.) Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects. C.) Assure the patient that the side effects from chemotherapy are merely uncomfortable, not life threatening. D.) Inform the patient that chemotherapy-related alopecia is usually permanent but can be managed with lifelong use of wigs.
B. Patients should always be taught what to expect during a course of chemotherapy, including side effects and expected outcome. Side effects of chemotherapy are serious and may cause death, but its important that patients be informed about what measures can be taken to help them cope with the side effects of therapy. Hair loss related to chemotherapy is usually reversible, and short-term use of wigs, scarves, or turbans can be used during and following chemotherapy until the hair grows back.
7.) A client who is receiving chemotherapy develops stomatitis. Which of the following actions is appropriate for the nurse to incorporate into the plan of care? A.) Rinse client's mouth with full-strength hydrogen peroxide every 4 hours. B.) Encourage client to use a soft bristled toothbrush after each meal. C.) Provide hot tea with honey to soothe the client's painful oral mucosa. D.) Avoid using dental floss until the client's stomatitis is resolved.
B. Stomatitis is an inflammation of the mucous membranes of the mouth resulting from chemotherapy. Using a soft-bristled toothbrush prevents further bleeding and irritation to the already irritated bums and mucous membranes. Hydrogen peroxide can further irritate the mouth. Fluids need to be lukewarm instead of hot; dental floss can be used if its done gently.
The nurse knows that the patient with lung cancer using an incentive spirometer requires more teaching when they say: A. "I should take normal breaths in between each session to avoid getting overly tired." B. "To use the incentive spirometer, I put the device in my mouth and breathe out as much as I can." C. "Using the incentive spirometer shortly after I eat can cause nausea." D. "The incentive spirometer allows my lungs to fill to their best ability."
B. The incentive spirometer is used to improve ventilation by allowing for maximum alveolar filling through sustained maximum inhalation, not by exhalation. A method that would use that physiologic mechanism is pursed-lip breathing.
A patient with newly diagnosed lung cancer tells the nurse, "I think I am going to die pretty soon, maybe this week." The best response by the nurse is: A. "Are you afraid that the treatment for your cancer will not be effective?" B. "Can you tell me what it is that makes you think you will die so soon?" C. "Would you like to talk to the hospital chaplain about your feelings?" D. "Do you think that taking an antidepressant medication would be helpful?"
B: The nurse's initial response should be to collect more assessment data about the patient's statement. The answer beginning "Can you tell me what it is" is the most open-ended question and will offer the best opportunity for obtaining more data. The answer beginning, "Are you afraid" implies that the patient thinks that the cancer will be immediately fatal, although the patient's statement may not be related to the cancer diagnosis. The remaining two answers offer interventions that may be helpful to the patient, but more assessment is needed to determine whether these interventions are appropriate.
The client is admitted to the outpatient surgery center for a bronchoscopy to rule out cancer of the lung. Which information should the nurse teach? A. The test will confirm the MRI results B. The client can eat and drink immediately after the test. C. The HCP can do a biopsy of the tumor through the scope. D. There is no discomfort associated with this procedure.
C, The HCP can take biopsies and wash of the lung tissue for pathological diagnosis during the procedure. Eating or drinking is not recommended until the local anesthetic has worn off. There is no guarantee the client will not experience discomfort Bronchoscopies are performed to confirm a diagnosis, not another test.
9.) When preparing to administer a chemotherapeutic agent to a client, the nurse should take which of the following measures? A.) Recap all needles used to prepare agents. B.) Dispose of chemotherapy wastes in the client's bedside trash. C.) Use gloves and disposable long-sleeved gowns when handling agents. D.) Administer only prepackaged agents from the manufacturer.
C. Chemotherapeutic agents are very toxic; therefore, precautions are taken such as the use of gloves and long-sleeved gowns when handling agents to prevent incidental contact with the skin. Recapping needles is against universal precaution standards, and chemotherapy waste is disposed of in biohazard containers according to institution policy. Prepackaged agents can still be hazardous if not handled properly.
3.) As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of the greatest bone marrow suppression. The nurse understands that further teaching is needed when the client states: A.) "I should avoid blowing my nose." B.) "I may need a platelet transfusion if my platelet count is too low." C.) "I'm going to take aspirin for my headache as soon as I get home." D.) "I will count the number of pads and tampons I use when menstruating."
C. During the period of greatest bone marrow suppression, the platelet count may be low, less than 20,000 cells/mm3. Option "C" describes an incorrect statement by the client. Aspirin and non-steroidal anti-inflammatory drugs and product that contain aspirin should be avoided because of their antiplatelet activity.
5.) A client receiving chemotherapy for cancer has an elevated serum creatinine level. The nurse should next: A.) Cancel the next scheduled chemotherapy. B.) Administer the scheduled dose of chemotherapy. C.) Notify the HCP. D.) Obtain a urine specimen.
C. Nephrotoxicity of a chemotherapy agent 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 due to chemotherapy so the nurse should consult the HCP for guidance. Administering the next dose of chemotherapy could potentially cause further kidney damage. It's inappropriate to cancel the chemotherapy without checking with the HCP. A urine specimen will not provide other helpful information.
The nurse enters the room of a client with COPD. The client's nasal cannula O2 is running at a rate of 6L per min and shallow. What is the nurse's best initial action? A) Take heart rate and bloodpressure B) Call the physician C) Lower the O2 rate D) Position the patient in a fowler's position
C: The client with COPD is suffering from chronic CO2 retention. The hypoxia drive is his chief stimulus for breathing. Giving O2 inhalation at a rate that is more than 2-3L/min can make the client lose his hypoxia drive which can be assessed as decreasing RR.
8. Which of the following should the nurse include when providing health teachings for patients at risk of developing prostatic cancer? A. Participate in smoking cessation program B. Perform monthly self-testicular examination C. Maintain daily walking exercise D. Undergo monthly digital rectal examination
Correct Answer: A Rationale: Smoking increases risk for prostatic cancer. Choice B is done to detect cancer of the testes. Choice D, digital rectal examination is recommended annually, not monthly.
6. Which is the American Cancer Society's recommendation for the early detection of cancer of the prostate? A. A yearly PSA level and DRE beginning at the age of 50 B. A biannual rectal exam beginning at the age of 40 C. A semi annual alkaline phosphatase level beginning at age 45. D. A yearly urinalysis to determine the presence of prostatic fluid.
Correct Answer: A Rationale: The American Cancer Society recommends all men to have yearly prostate specific antigen (PSA) blood level, followed by a digital rectal exam (DRE) beginning at the age of 50. Men is high risk group including African American should begin at the age of 45. NOT: 6 month exams aren't necessary, choice C- this test is performed on clients who have prostate cancer- to determine bone involvement, choice D-will shows signs and symptoms of prostatis.
A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client? A. Bed rest B. Out of bed ad lib C. Out of bed in a chair only D. Ambulation to the bathroom only
Correct Answer: A Rationale: The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.
The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing: A. Rupture of the bladder B. The development of a vesicovaginal fistula C. Extreme stress caused by the diagnosis of cancer D. Altered perineal sensation as a side effect of radiation therapy
Correct Answer: B Rationale: A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client's complaint is not associated with options A, C, and D.
10. The client states, "I heard that all men get prostate cancer sometime in their lives." In teaching the client about cancer incidence, the best response is based on the understanding that: A. Lung cancer is the most frequently diagnosed cancer in men B. Prostate cancer is the most frequently diagnosed cancer in men C. Prostate cancer is the most prevalent in Caucasian men D. There is no way to screen for prostate cancer, so it is the most common cause of cancer death in men
Correct Answer: B Rationale: Prostate cancer is the most common cancer in men in the U.S., with lung cancer being second. The incidence of prostate cancer is significantly higher in African-American men worldwide. Screening is available for prostate cancer.
The client is undergoing radiation therapy to treat lung cancer. Following treatment, the nurse notes erythema on the client's chest and neck, and the client is complaining of pain at the radiation site. The nurse interprets this assessment data a(n): A. allergic reaction to the radiation B. superficial injury to tissue from the radiation C. cutaneous reaction to products formed by the lysis of the neoplastic cells D. ischemic injury, much like pressure ulcer formation. caused by pressure from the linear accelerator
Correct Answer: B Rationale: Superficial injury from radiation can manifest with erythema (probably caused by capillary damage), hyperpigmentation (from stimulation of melanocytes), dry desquamation (caused by basal cell destruction), or moist desquamation (also caused by basal cell destruction). Moist desquamation is comparable to a second-degree burn in histology, appearance, and sensation.
A client with renal cancer is being treated preoperatively with radiation therapy. The nurse evaluates that the client has an understanding of proper care of the skin over the treatment field if the client states to: A. wash the ink marks off the skin B. avoid skin exposure to direct sunlight C. apply perfumed lotion to the affected skin D. wear tight clothing over the skin site to provide support
Correct Answer: B Rationale: The client undergoing radiation therapy should wash the site using mild soap and warm or cool water and pat the area dry. No lotions, creams, alcohol, perfumes, or deodorants should be placed on the skin over the treatment site. Lines or ink marks that are placed on the skin to guide the radiation therapy should be left in place. The affected skin should be protected from temperature extremes, direct sunlight, and chlorinated water (as from swimming pools). The client should wear cotton clothing over the skin site and guard against irritation from tight or rough clothing such as belts or bras.
The nurse is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which principle? A. Limit the time with client to 1 hour per shift B. Do not allow pregnant women into the clients room C. Remove the dosimeter film badge when entering the room D. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6 feet away from the client
Correct Answer: B Rationale:: The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8 hours shifts. The dosimeter film badge may be worn when in the clients room. Children younger than 16 years of age and pregnant woman are not allowed in patients room.
The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is: A. Dyspnea B. Diarrhea C. Sore throat D. Constipation
Correct Answer: C Rationale: In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat. Options B and D may occur with radiation to the gastrointestinal tract. Dyspnea may occur with lung involvement.
External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient that an important measure to prevent complications from the effects of a. test all stools for the presence of blood. b. inspect the mouth and throat daily for the appearance of thrush. c. perform perianal care with sitz baths and meticulous cleaning. d. maintain a high-residue, high-fat diet.
Correct Answer: C Rationale: Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.
9. The nurse is preparing the care plan for a 45 year old client who has had a radical prostatectomy. Which psychosocial and physiological problem should be included in the plan? A. Altered Coping B. High risk for hemorrhage C. Sexual Impotence D. Risk for electrolyte imbalance.
Correct Answer: C Rationale: This option focuses on both the psychological AND the physiological.
The client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in bed. The initial action by the nurse is to A. Call the physician B. Reinsert the implant into the vagina immediately C. Pick up the implant with gloved hands and flush it down the toilet D. Pick up the implant with long-handled forceps and place it in a lead container
Correct Answer: D Rationale: A lead container and long-handled forceps should be kept in the clients room at all times during internal radiation therapy. If the implant becomes dislodged, the nurse should pick up the implant with long-handled forceps and place it in the lead container. Options a, b, and c are inaccurate interventions.
A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first? A. Stand as far away from the implant as possible and call for help. B. Pick up the implant with long-handled forceps and place it in a lead-lined container. C. Leave the room and notify the radiation therapy department immediately. D. Put the implant back in place, using forceps and a shield for self-protection, and call for help.
Correct answer: B Rationale: If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled forceps and place it in a lead-lined container, then notify the radiation therapy department immediately. The highest priority is to minimize radiation exposure for the client and the nurse; therefore, the nurse must not take any action that delays implant removal. Standing as far from the implant as possible, leaving the room with the implant still exposed, or attempting to put it back in place can greatly increase the risk of harm to the client and the nurse from excessive radiation exposure.
The Nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung. Which information is significant for this disease? A. The client worked with asbestos for a short time many years ago. B. The client has no family history for this type of lung cancer. C. The client has numerous tattoos covering both upper and lower arms. D. The client smoked two (2) packs of cigarettes a day for 20 years.
D, Smoking is the number-one risk factor for developing cancer of the lung. More than 85% of lung cancers are attributable to inhalation of chemicals. There are more than 400 chemicals in each puff of cigarette smoke, 17 of which are known to cause cancer
2.) The client receiving chemotherapy is experiencing mucositis. The nurse advises the client to use which of the following as the best substance to rinse the mouth? A.) Alcohol-based mouthwash. B.) Hydrogen peroxide mixture. C.) Lemon-flavored mouthwash. D.) Weak salt and bicarbonate mouth rinse.
D. An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral rinse.
The nurse is conducting an education session for a group of smokers in a "stop smoking" class. Which finding would the nurse state as a common symptom of lung cancer? A) Dyspnea on exertion B) Foamy, blood-tinged sputum C) Wheezing sound on inspiration D) Cough or change in a chronic cough
D: Cigarette smoke is a carcinogen that irritates and damages the respiratory epithelium. The irritation causes the cough which initially may be dry, persistent and unproductive. As the tumor enlarges, obstruction of the airways occurs and the cough may become productive due to infection.
