Cancer set

A client who is receiving chemotherapy develops stomatitis. What should the nurse instruct the client to do? A. Rinse the mouth with full-strength hydrogen peroxide every 4 hours B. Use a soft-bristled toothbrush after each meal C. Drink hot tea with honey to soothe the painful oral mucosa D. Avoid using dental floss until the 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 gums and mucous membranes

A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her parents live 750 miles away and have only been able to visit twice since her initial diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose chemotherapy. She is concerned about her children's welfare during the treatment. When assessing the client's present support systems, the nurse will be most concerned about the potential problems with: A. Denial as a primary coping mechanism B. Support systems and coping strategies C. Decision-making abilities D. Transportation and money for the boys

B The client's resources for coping with the emotional and practical needs of herself and her family need to be assessed because usual coping strategies and support systems are often inadequate in especially stressful situations

The nurse teaches the client with chronic cancer pain about optimal pain control. Which recommendation is most effective for pain control? A. Get used to some pain, and use a little less medication than needed to keep from being addicted. B. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain C. Take analgesics only when pain returns D. Take enough analgesics around the clock so that you can sleep 12 to 16 hours a day to block the pain

B The regular administration of analgesics provides a consistent serum level of medication, which can help prevent breakthrough pain.

A client with chronic cancer pain has been receiving opiates for 4 months. She rated the pain as an 8 on a 10-point scale before starting the opioid medication. Following a thorough examination, there is no new evidence of increased disease, yet the pain is close to 8 again. The most likely explanation for the increasing pain is: A. Development of an addiction to the opioids B. Tolerance to the opioid C. Withdrawal from the opioid D. Placebo effect has decreased

B Tolerance to an opioid occurs when a larger dose of the analgesic is needed to provide the same level of pain control.

The nurse is assessing a client with chronic pain. What findings are expected for a client in chronic pain? (Select all that apply) A. Facial grimacing B. Normal vital signs C. Physical inactivity D. Moaning E. Depression

B,C In the client with chronic pain, physiologic adaptation results in minimal changes in behavior and vital signs; clients have normal vital signs and are generally physically inactive.

Which nursing intervention would be most helpful in improving the respiratory effort of a client with metastatic lung cancer? A. Teaching the client diaphragmatic breathing techniques B. Administering cough suppressants as prescribed C. Teaching and encouraging pursed-lip breathing D. Placing the client in a low semi-fowler's position

C For clients with obstructive versus restrictive disorders, extending exhalation through pursed-lip breathing will make the respiratory effort more efficient.

A client receiving radiation to the head and neck is experiencing stomatitis. The nurse should recommend: A. Evaluation by a dentist B. Alcohol-based mouthwash rinses C. Artificial saliva D. Vigorous brushing of teeth after each meal

C Head and neck radiation can cause the complication of stomatitis and decreased salivary flow.

Which strategy will be most effective in improving transcultural communications with client with cancer and their families? A. Use touch to show concern and caring for the client B. Focus attention on verbal communication skills only C. Establish a rapport and listen to their concerns D. Maintain eye contact at all times

C It is important to establish rapport with the client and family by listening to verbal and nonverbal concern and showing respect for cultural differences.

The young sister of a young adult client with leukemia asks, "Can you check my blood? When my sister got pneumonia, so did I. And I think I have this, too." How should the nurse respond? (Select all that apply) A. Ask the client's healthcare provider to take a sample of the sister's blood B. Explain to the sister that leukemia is not a communicable disease C. Discuss the sister's concern with her parents D. Tell the sister's parents about a group for siblings of clients with terminal illness E. Ask the sister about her concerns

C,D,E The nurse should first determine the sister's concerns, and then alert the parents to the sister's concerns and also tell the parents about resources that are available to assist siblings to cope with a terminal illness in the family.

An older woman who is usually meticulous about her appearance and dress arrives today for her 23rd day of radiation therapy. She appears disheveled and emotionally labile, and her responses to the usual questions are a little inappropriate. Her heart rate is 124, her respirations are 32, and her skin is cold and clammy. These findings would suggest that the nurse should further assess the client for: A. Schizophrenia B. Panic disorder C. Depression D. Delirium

D Tachycardia, tachypnea, moist or clammy skin, and disorientation are classic symptoms of delirium

A client is to start chemotherapy to treat lung cancer. A venous access device has been placed to permit administration of chemotherapeutic medications. Three days later at the scheduled appointment to receive chemotherapy, the nurse assesses that the client is dyspneic and the skin is warm and pale. The vital signs are blood pressure 80/30, pulse 132, respirations 28, temperature 103, and oxygen saturation 84%. The central line insertion site is inflamed. After calling the rapid response team, what should the nurse do next? A. Place cold, wet compresses on the client's head B. Obtain a portable ECG monitor C. Administer a prescribed antipyretic D. Insert a peripheral intravenous fluid line and infuse normal saline

D The client is experiencing severe sepsis, and it is essential to increase circulating fluid volume to restore the blood pressure and cardiac output.

A client is beginning external beam radiation therapy to the right axilla after a lumpectomy for breast cancer. Which information should the nurse include in client teaching? A. Use a heating pad under the right arm. B. Immobilize the right arm C. Place ice on the area after each treatment D. Apply deodorant only under the left arm

D The nurse should instruct the client to avoid applying chemicals or heat or cold to the are being treated.

The 65-year-old widower whose only son is 500 miles away is at higher risk for psychosocial distress because the client: A. Has been successful in dealing with stress all his life B. Does not have to deal with other stressors right now C. Is able to use denial as a coping mechanism D. Perceives he has minimal social support

D The person who has minimal social support, has not been successful in dealing with stressors, and has multiple other stressors is at greater risk for psychosocial distress

A 42-year-old husband and father of 7-year-old girl and a 10-year-old boy is concerned about what he should tell his children regarding his wife's impending death from aggressive breast cancer. The nurse should first: A. Refer the family to pastoral care services B. Encourage the husband to come to terms with his own grief C. Suggest that the healthcare provider tell the children about the seriousness of their mother's illness D. Begin education about strategies for communication with his children

D Without clear, consistent communication, the parent-child relationship may become strained during the illness and subsequent death of a parent. A great number of parents do not know how to communicate with their children, especially about difficult emotional topics at a time when they are also under great emotional stress. The nurse should begin by providing information and developmentally appropriate books about the grieving process for children

The nurse is assessing a 60-year-old who has hoarseness and a chronic sore throat. What should the nurse determine while conducting a focused assessment? (Select all that apply) A. Use of acetaminophen B. exposure to sun C. Consumption of a high-fat diet D. History of tobacco use E. Amount of alcohol sonsumption

D,E Hoarseness and chronic sore throat are indicative of cancer of head and neck cancers, particularly cancer of the pharynx. Tobacco use and heavy consumption of alcohol are risk factors for these cancers and may have a synergistic effect.

A 45-year-old male presents with persistent, severe stomach pain. Testing reveals a peptic ulcer. Further laboratory tests reveal the presence of Helicobacter pylori. Which of the following is of concern for this patient? a. Gastric cancer b. Leukemia c. Lung cancer d. Adenocarcinoma of the colon

a. Gastric cancer Rationale: The presence of Helicobacter pylori is associated with gastric cancer.

A patient has a tissue growth that was diagnosed as cancer. Which of the following terms best describes this growth? a. Neoplasm b. Lipoma c. Meningioma d. Hypertrophy

a. Neoplasm

Which of the following indicates a nurse understands a proto-oncogene? A proto-oncogene is best defined as a(n) _____ gene. a. Normal b. Altered c. Inactive d. Tumor-suppressor

a. Normal Rationale: In its normal, nonmutant state, an oncogene is referred to as a proto-oncogene.

A 25-year-old male develops a tumor of the breast glandular tissue. What type of tumor will be documented on the chart? a. Carcinoma b. Adenocarcinoma c. Sarcoma d. Lymphoma

b. Adenocarcinoma Rationale: Tumors that arise from or form ductal or glandular structures are named adenocarcinomas. Cancers arising in epithelial tissue are called carcinomas. Cancers arising from mesenchymal tissue (including connective tissue, muscle, and bone) usually have the suffix sarcoma. Cancers of lymphatic tissue are called lymphomas.

An oncologist is discussing when a cancer cell loses differentiation. Which of the following is the oncologist describing? a. Autonomy b. Anaplasia c. Pleomorphic d. Metastasis

b. Anaplasia Rationale: Anaplasia is the loss of differentiation.

A 30-year-old female is diagnosed with cancer. Testing reveals that the cancer cells have spread to local lymph nodes. A nurse realizes this cancer would be documented as stage: a. 1 b. 2 c. 3 d. 4

c. 3 Rationale: Cancer that has spread to regional structures, such as lymph nodes, is stage 3. Cancer confined to the organ of origin is stage 1. Cancer that is locally invasive is stage 2. Cancer that has spread to distant sites, such as a liver cancer spreading to lung or a prostate cancer spreading to bone, is stage 4.

A nurse is discussing preinvasive epithelial tumors of glandular or squamous cell origin. What is the nurse describing? a. Tumor in differentiation b. Dysplastic c. Cancer in situ d. Cancer beyond (meta) situ

c. Cancer in situ Rationale: Early stage growths that are localized to the epithelium and have not invaded are called cancer in situ.

Which information indicates a nurse understands characteristics of malignant tumors? a. Grows slowly b. Has a well-defined capsule c. Has a high mitotic index d. Is well-differentiated

c. Has a high mitotic index

A 45-year-old female was recently diagnosed with cervical cancer. She reports a sexual history that includes 43 partners. Which of the following is the most likely cause of her cancer? a. Herpes virus b. Rubella virus c. Human papillomavirus (HPV) d. Hepatitis B virus

c. Human papillomavirus (HPV)

Which statement indicates the patient has a correct understanding of metastasis? The most common route of metastasis is through the blood vessels and: a. Lung tissue b. Body cavities c. Lymphatics d. Connective tissues

c. Lymphatics

Of the following genetic lesions that cause cancer, which is the most common? a. Insertions b. Deletions c. Point mutations d. Amplification

c. Point mutations Rationale: Several types of genetic events can activate oncogenes. The most common are small scale changes in DNA called point mutations.

Which information should the nurse include when teaching about angiogenic factors? In cancer, angiogenic factors stimulate: a. Release of growth factors b. Tumor regression c. Apoptosis d. New blood vessel growth

d. New blood vessel growth Rationale: Cancers can secrete multiple factors that stimulate new blood vessel growth, which is called angiogenesis.

A 42-year-old client with breast cancer is concerned that her husband is depressed by her diagnosis. Which change in her husband's behavior may confirm her fears? A. Increased decisiveness B. Problem-focused coping style C. Increase in social interactions D. Disturbance in his sleep patterns

D Depression can be a mixture of affective responses, behavioral responses, and cognitive responses.

The incidence and risk of cancer increase when smoking is combined with: A. Asbestos exposure and alcohol consumption B. Ultraviolet radiation exposure and alcohol consumption C. Asbestos exposure and ultraviolet radiation exposure D. Alcohol consumption and human papillomavirus (HPV) infection.

A Asbestos and alcohol, when combined with smoking, produce a synergistic effect and result in increased cancer risk and incidence.

The most reliable early indicator of infection in a client who is neutropenic is: A. Fever B. Chills C. Tachycardia D. Dyspnea

A Fever is an early sign requiring clinical intervention to identify potential causes.

Which philosophy should the nurse integrate into the plan of care for a client and family to help them best cope during the final stages of the client's illness? A. Living each day as it comes as fully as possible B. Reliving the pleasant memories of days gone by C. Expecting the worse and being grateful when it does not happen D. Planning ahead for the remaining good times that will be spent together

A When supporting the friends or family of a terminally ill client, it is best to focus on the present. This can be accomplished by living each day to its fullest

Which information should be included in the teaching plan for a client with cancer who is experiencing thrombocytopenia? (Select all that apply) A. Use an electric razor B. Use a soft-bristle toothbrush C. Avoid frequent flossing for oral care D. Include an over-the-counter nonsteroidal anti-inflammatory (NSAID) daily for pain control E. Monitor temperature daily F. Report bleeding, such as nosebleed, petechiae or melena, to a healthcare provider

A,B,C,F Thrombocytopenia places the client at risk for bleeding. Therefore, electric razors will reduce the potential for skin nicks and bleeding. Oral hygiene should be provided with a soft tooth-brush and with minimal friction to gently clean without trauma. Clients should evaluate mucous membranes, skin, stools, or other sources of potential bleeding

A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife: (Select all that apply) A. Gives her husband a long-acting or sustained-release oral pain medication regularly around the clock. B. Uses an immediate-release medication for breakthrough pain C. avoids long-acting opioids due to her concern about addiction. D. Avoids music for distraction as well as heat or cold in combination with medications. E. Substitutes acetaminophen to avoid tolerance to the medications. F. Has her husband use a pain rating scale to measure the effectiveness at reaching his individual pain goal.

A,B,D,F Scheduled use of long-acting opioids and an around-the-clock dosing are necessary to achieve a steady level of analgesia. Whatever the route or frequency, a prescription should be available for "breakthrough" pain medication to be administered in addition to the regularly scheduled medication.

The nurse is planning future care with a middle-aged woman who has undergone surgical resection for lung cancer. Which plan will best promote adaptation and rehabilitation? A. Arranging a visit from a client who has recovered from a similar surgery B. Planning a progressive activity regimen C. Teaching about dressing care D. Requesting house cleaning services for 3 months

B A progressive activity regimen may be prescribed to increase pulmonary function after surgical lung resection

When talking with the nurse, the brother of a client with leukemia says, "We used to play pretty rough fames together. Maybe some of the bruises he got when I tackled him caused this." Which statement is the nurse's best response? A. "Do not feel guilty. You did not cause your brother's illness." B. "I can see you are worried. Let us talk about how people get leukemia." C. "Here is some information about leukemia for you to read." D. "Lots of people worry about things like this. It is not your fault."

B A response that acknowledges the brother's concern and provides him with information is most helpful. Therefore, telling the brother that the nurse sees that he is worried and then following this up with a discussion about leukemia is most appropriate.

An adult with a history of COPD and metastatic carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice program. The nurse should conduct a focused client assessment for: A. Ascites B. Pleural friction rub C. Dyspnea D. Peripheral edema

B Alopecia from chemotherapy is temporary. The new hair will not be necessarily gray, but the texture and color of new hair growth may be different.

A client undergoing chemotherapy tells the nurse, "I do not want to get out of bed in the morning, because I am so tired." The nursing plan of care should include: A. Education on the use of filgrastim B. Individually tailored exercise program C. Weight lifting when not experiencing fatigue D. Bed rest until chemotherapy is complete

B An individualized exercise program will increase stamina and endurance

A client suspects that he will not live. However, others talk about only pleasant matters with him and maintain a persistently cheerful façade around him. The nurse plans care for this client by recognizing that these behaviors will most likely cause the client to feel: A. Relief B. Isolated C. Hopeful D. Independent

B Clients tend to experience isolation and loneliness when those around them are trying to hide or mask the truth.

When explaining hospice care to a client, the nurse should tell the client: A. "Hospice care uses a team approach to direct hospice activity" B. "Clients and their families are the focus of care" C. "Your healthcare provider coordinates all the care" D. "All hospice clients will die at home"

B The most important central component of hospice care is focus of care on the client as well as the family or significant other.

While talking to her husband, who is caring for their children, a middle-aged woman who has stage 4 breast cancer slams the phone down. She begins to cry and states that she is feeling guilty for being hospitalized. Which nursing action will best support the client emotionally? A. Ask the client if she would like to speak with a grief counselor B. Call the healthcare provider and request an antidepressant C. Sit with the client, and help her acknowledge and discuss her feelings D. Suggest the client call her husband when she is calmer

C Acknowledgment and discussion of the client's feelings begin the establishment of a therapeutic relationship between nurse and client

A client at risk for lung cancer asks about the reason for having a computed tomography (CT) scan as part of the initial exam. What is the nurse's best response? "A CT scan is: A. Far superior to magnetic resonance imaging for evaluating lymph node metastasis." B. Noninvasive and readily available." C. Useful for distinguishing small differences in tissue density and detecting nodal involvement." D. Used to distinguish a malignant from a non-malignant adenopathy."

C CT scanning is the standard noninvasive method used in a workup for lung cancer because it can distinguish small differences in tissue density and can detect nodal involvement.

The client who is receiving chemotherapy is not eating well but otherwise feels healthy. What should the nurse suggest the client eat? A. Cereal with milk and strawberries B. Toast, gelatin dessert, and cookies C. Broiled chicken, green beans, and cottage cheese D. Steak and french fries

C Carbohydrates are the first substance used by the body for energy. Proteins are needed to maintain muscle mass, repair tissue, and maintain osmotic pressure in the vascular system. Fats, in small amount, are needed for energy production.

When preparing to administer a chemotherapeutic agent to a client, the nurse should: 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 skin

The nurse is instructing a client about skin care while receiving radiation therapy to the chest. What should the nurse instruct the client to do? A. Apply lotion if the skin becomes dry B. Shave the chest to prevent contamination C. Wash the area with tepid water and mild soap D. Keep the area covered with a non-adherent dressing between treatments

C Clients receiving radiation experience dryness or redness in the area of the radiation. The nurse instructs the client to wash the area with soap and water and keep the area dry

A client receiving chemotherapy for cancer has an elevated serum creatinine level. The nurse should do 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 caused by chemotherapy is assessed by monitoring serum creatinine. Creatinine is the most sensitive indicator of proper kidney function. In this case, the client is experiencing decreased kidney function, most likely due to the chemotherapy. The nurse consults the HCP for guidance.

An appropriate nursing intervention for a client with fatigue related to cancer treatment includes teaching the client to: A. Increase fluid intake B. Minimize naps or periods of rest during the day C. Conserve energy by prioritizing activities D. Limit dietary intake of high-fiber foods

C Prioritizing physical activities helps to conserve energy, which promotes adaptation to fatigue.

The nurse is caring for a client who is receiving external beam radiation therapy for treatment of lung cancer should assess the client for: A. Diarrhea B. Improved energy level C. Dysphagia D. Normal white blood cell count

C Radiation-induced esophagitis with dysphagia is particularly common in clients who receive radiation to the chest

An adult is dying from metastatic lung cancer, and all treatments have been discontinued. The client's breathing pattern is labored, with gurgling sounds. The client's spouse asks the nurse, "Can you do something to help with the breathing?" Which is the nurse's best response in this situation? A. Direct the UAP to assess the client's vital signs and provide oral care B. Suction the client so that the client's spouse knows all interventions were performed C. Reposition the client, elevate the head of the bed, and provide a cool compress D. Explain to the spouse that it is standard practice not to suction clients when treatments have been discontinued

C Repositioning the client, elevating the head of the bed, and providing cool compress are comfort interventions consistent with the concept of palliative care of the dying.

A nurse is planning an educational program about cancer prevention and detection. Which group would benefit most from education regarding potential risk factors for melanoma? A. Adults older than age 35 B. Senior citizens who have been repeatedly exposed to the effects of ultraviolet A and ultraviolet B rays C. Parents with children D. Employees of chemical factory

C Sun damage is a cumulative process. Parents should be taught to apply sunscreen at an early age. Although preventive education is always valuable, serious sunburns in childhood are associated with an increased risk of melanoma. Adults and senior citizens have already been exposed to the harmful effects of the sun and, although they, too, should use sunscreen, they are not the group that will most benefit from intervention.

The nurse is making a follow-up telephone call to a 52-year-old client with lung cancer. The client now has a low-grade fever 100.6, nonproductive cough, and increasing fatigue. The client completed the radiation therapy to the mass in the right lung and mediastinum 10 weeks ago and has a follow-up appointment to see the healthcare provider in 2 weeks. The nurse should advise the client: A. To take two acetaminophen tablets every 4 to 6 hours for 2 days and call the healthcare provider if the temperature increases to 101 or greater B. That this is an expected side effect of the radiation therapy and to keep his appointment in 2 weeks C. To contact the healthcare provider for an appointment today D. To go to the nearest emergency department

C The client is exhibiting early symptoms of pulmonary toxicity as a result of the radiation therapy. These are not expected adverse effects of radiation. The client should be examined to differentiate between an infection and radiation pneumonitis.

The nurse is planning with a client who has cancer improve the client's independence om activities of daily living after radiation therapy. What should the nurse do? A. Refer the client to a community support group after discharge from the rehabilitation unit B. Make certain that a family member is present for the rehabilitation sessions C. Provide positive reinforcement for skills achieved D. Inform the client of rehabilitation plans made by the rehabilitation team

C The positive reinforcement builds confidence and facilitates achievement of rehabilitation goals

A client with cancer who is receiving radiation therapy develops thrombocytopenia. The priority nursing goal is to prevent: A. Pain related to spontaneous bleeding episodes B. Altered nutrition related to anemia C. Injury related to the decreased platelet count D. Skin breakdown related to decreased tissue perfusion

C This client is at high risk for bleeding because of the decreased platelet count. The priority nursing goal is to prevent injury to this client by preventing bleeding occurrences.

A client is receiving vincristine. Client teaching by the nurse should include instruction on: A. Use of loperamide B. Fluid restriction C. Low-fiber, bland diet D. Bowel regimen

D A side effect of vincristine is constipation, and a bowel protocol should be considered

A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which recommendation is appropriate? A. Apply sunscreen only after going into the water B. Avoid peak exposure hours from 0900 to 1300 C. Wear loosely woven clothing for added ventilation D. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure

D A sunscreen with an SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It should be applied before sun exposure and reapplied after being in the water.

A nurse is conducting a cancer risk screening program. Which client is at greatest risk for skin cancer? A. A 45-year-old healthcare worker B. A 15-year-old high school student C. A 30-year-old butcher D. A 60-year-old mountain biker

D Basal cell carcinoma occurs most commonly in sun-exposed areas of the body. The incidence of skin cancer is highest in older people who live in the mountains or spend outdoor leisure time at higher altitudes

The most cost-effective suggestion for bereavement support for the hospice nurse to give a woman whose husband died 3 months ago and her three young children would be to: A. Seek group counseling support for the three children B. Request individual counseling and medication to manage depression C. Remind her gently that bereavement care before death minimizes grieving D. Continue bereavement support offered through hospice

D Bereavement support after death usually continues for about 1 year or as needed at little or no cost to the remaining family

A client is receiving chemotherapy that has the potential to cause pulmonary toxicity. Which signs or symptoms indicate a toxic response to the chemotherapy? A. Decrease in appetite B. Drowsiness C. Spasms of the diaphragm D. Cough and shortness of breath

D Cough and shortness of breath are significant symptoms because they may indicate decreasing pulmonary function secondary to drug toxicity.

Which nursing intervention will be most effective when caring for a client who is experiencing powerlessness? A. Make certain that all staff members focus only on the client's capabilities B. Encourage family members to become more responsible for the client's care C. Request a referral to a psychologist D. Include the client in decision making whenever possible

D Focusing on the client's physical capabilities is important, but powerlessness reflects a perceived lack of control over the current situation and the belief that one's actions will not affect the outcome

The nurse is counseling the family of an older adult who died today. Which factor facilitates attainment of a positive bereavement outcome? A. Being a teenager B. Having a history of anxiety C. Being a spouse D. Possessing adequate financial resources

D Having adequate financial resources facilitates bereavement. Younger people are at higher risk for negative bereavement outcomes

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

D Identifying available resources for the client and family represents a respectful effort to make options available and encourages the client to become involved in treatment decisions.

Which factor is most important to assess when determining the impact of the cancer diagnosis and treatment modalities on a long-term survivor's quality of life? A. Occupation and employability B. Functional status C. Evidence of disease D. Individuals values and beliefs

D Individuals with cancer have various cultural values and beliefs that help them cope with the cancer experience.

The client who is in end stages of cancer is requesting spiritual support. The nurse should: A. Inform the family and ask for their suggestions B. Call a chaplain and set up an appointment for spiritual guidance C. Help the client reflect on past accomplishments D. Ask the client with spiritual activities would be most helpful

D It is important to allow the client to choose his or her own form of spiritual support, and the nurse begin by asking the client what would be most supportive now

A cancer survivor feels guilty when attending a cancer support group meeting. The nurse can help the client manage feelings of guilt by pointing out that: A. These actually are feeling of anger at the terminally ill clients in the group B. It is an unexpected response to volatile emotions C. This is a spiritual response to the client's own illness D. This is a normal reaction when surviving a life-threatening experience

D Many cancer survivors question why they are doing so well and other are not. Often, they express feeling guilty when they hear that others are not doing well.

A 52-year-old male was discharged from the hospital for cancer-related pain, His pain appeared to be well controlled on the IV morphine. He was switched to oral morphine when discharged 2 days ago. He now reports his pain as an 8 on a 10-point scale and wants the IV morphine. Which explanation is the most likely for the client's reports of inadequate pain control? A. He is addicted to the IV morphine B. He is going through withdrawal from the IV opioid C. He is physically dependent on the IV morphine D. He is under-medicated on the oral opioid

D Most clients with cancer who are experiencing inadequate pain control while taking an oral opioid after being switched from IV administration have been under-medicated. Equianalgesic conversions should be made to provide estimates of the equivalent dose needed for the same level of relief as provided by the IV dose

The most common issue associated with sleep disturbances in the hospitalized client with cancer is: A. Social B. Nutritional C. Cultural D. Psychological

D Most hospitalized persons are at risk for sleep disturbances. Psychological issues and pain are related to sleep deprivation.

Which is the most appropriate nursing intervention for a hospitalized client with pruritus caused by medications used to treat cancer? A. Administration of antihistamines B. Steroids C. Silk sheets D. Medicated cool baths

D Nursing interventions to decrease the discomfort of pruritus include those that prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated baths with salicylic acid or colloidal oatmeal can be soothing as a temporary relief

A nurse is assessing an adult who has been receiving chemotherapy. The client has a platelet count of 22,000 and has petechiae on the lower extremities. The nurse should advise the client to: A. Increase the amount of iron in the client's diet B. Apply lotion to the lower extremities C. Elevate the legs D. Consult the healthcare provider

D Petechiae are tiny, purplish, hemorrhagic spots visible under the skin. Petechiae usually appear when platelets are depleted.

Which activity indicates that the client with cancer is adapting well to body image changes? A. The client names his brother as the person to call if he is experiencing suicidal ideation B. The client continuously looks at the incision C. The client discusses a date to return to work D. The client serves as a volunteer in a client-to-client visitation program

D Serving as a volunteer in a client-to-client program represents reintegration with constructive channeling of energies, which indicates a higher level of adaptation than attention to safety, knowledge, or planned activity.

A client in a hospice program has increasing pain. The nurse and client collaborate to schedule analgesics to provide: A. Doses of analgesic when pain is a 5 on a scale of 1 to 10. B. Enough analgesia to keep the client semisomnolent. C. An analgesia-free period so that the client can carry out daily hygienic activities. D. Around-the-clock routine administration of analgesics for continuous pain relief.

D The desired outcome for management of pain is that the client's or family's subjective report of pain is acceptable and documented using a pain scale, the goal is that behavioral and physiologic indicators of pain are absent around the clock

When caring for a client who is experiencing spiritual distress, what should the nurse do first? A. Make a referral to a member of the clergy B. Explain the major beliefs of different religions C. Suggest reading material D. Help the client explore his or her own values and beliefs

D The nurse must first allow the client to explore his or her own beliefs and values before making referrals, explaining various religious beliefs, or suggesting appropriate reading material

A 52-year-old male with hepatitis C recently developed hepatic cancer. Which of the following markers should be increased? a. Alpha-fetoprotein (AFP) b. Catecholamines c. Prostate-specific antigen d. Homovanillic acid

a. Alpha-fetoprotein (AFP) Rationale: Liver and germ cell tumors secrete a protein known as AFP.

A client receiving chemotherapy has pruritus. In order to develop a care plan, the nurse should ask if the client has been: A. Wearing clothes made from 100% cotton B. Sleeping in a cool, humidified room C. Increasing fluid intake to at least 3,00 mL/day D. Taking daily baths with a deodorant soap

D Use of deodorant or fragrant soaps is drying to the skin.

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

A Clients with cancer report that the lifelong fear of recurrence is one of the most disruptive aspects of the disease

A patient has been researching telomere caps on the Internet. Which statement indicates the patient has a good understanding? Presence of telomere caps gives cancer cells: a. The ability to divide over and over again b. Clonal distinction c. Limited mitosis d. Mutation abilities

a. The ability to divide over and over again

A client diagnosed with cancer is receiving chemotherapy. The nurses should assess which diagnostic value while the client is receiving chemotherapy? A. Bone marrow cells B. Liver tissues C. Heart tissues D. Pancreatic enzymes

A The fast-growing, normal cells most likely to be affected by certain cancer treatments are blood-forming cells in the bone marrow, as well as cells in the digestive track, reproductive system, and hair follicles.

The nurse is teaching the client who is receiving chemotherapy and the family hoe to manage possible nausea and vomiting at home. The nurse should include information about: A. Eating frequent, small meals throughout the day B. Eating three normal meals a day C. Eating only cold foods with no odor D. Limiting the amount of fluid intake

A Dietary suggestions to reduce adverse effects of cancer and cancer therapies include a soft bland diet low in fat and sugar. Frequent, small meals are usually better tolerated.

A nurse is assessing a client with bone cancer pain. Which part of a thorough pain assessment is most significant for this client? A. Intensity B. Cause C. Aggravating factors D. Location

A Intensity is indicative of the severity of pain and is important for evaluating the efficacy of pain management.

Assessment of a client taking a non-steroidal anti-inflammatory drug (NSAID) for pain management should include specific questions regarding which body system? A. Gastrointestinal B. Renal C. Pulmonary D. Cardiac

A The most common toxicities from NSAIDs are gastrointestinal disorders.

During the initial stage of adaptation to the diagnosis of cancer and its treatment, the nurse can facilitate the client's adaptation by: A. Encouraging the client to maintain her usual role B. Facilitating family-related disagreements and conflicts C. Supporting the client in her use of denial as a coping strategy D. Arranging transportation and child care on treatment days

A Maintaining role function has been found to be a supportive source of normalcy and positive self-esteem for the client and family during the cancer experience

The nurse is conducting a cancer risk assessment for a middle-aged client. Which environmental factor increases the risk of cancer? A. Gender B. Nutrition C. Immunologic status D. Age

B Environmental factors include place of residence, nutrition, occupation, personal habits, iatrogenic factors, and physical environment.

A client with suspected lung cancer is undergoing a thoracentesis. Which outcomes of the procedure are expected? (Select all that apply) A. Treatment of recurrent malignant effusion B. Diagnosis of underlying disease C. Palliation of symptoms D. Relief of acute respiratory distress E. Removal of cancer cells

B,C,D Thoracentesis is usually successful for diagnosis of underlying disease, palliation of symptoms, and treating the acute respiratory distress; alleviation of the symptoms and distress is usually short term.

A 29-year-old woman is concerned about her personal risk factors for malignant melanoma. She is upset because her 49-year-old sister was recently diagnosed with the disease. After gathering information about the client's history of sun exposure, the nurse's best response would be to explain that: A. Some melanomas have a familial component, and she should seek medical advice B. Her personal risk is low because most melanomas occur at age 60 or later C. Her personal risk is low because melanoma does not have a familial component D. She should not worry because she did not experience severe sunburn as a child

A Malignant melanoma may have a familial basis, especially in families with dysplastic nevi syndrome. First-degree relatives should be monitored closely

A client who is in the end stages of cancer is increasingly upset about receiving chemotherapy. Which approach by the nurse would likely be most helpful in gaining the client's cooperation? A. Tell the client how the treatment can be expected to help B. Describe the probable effect that missing a treatment would have C. Explain that being upset makes the treatment more difficult D. Suggest having a massage during the treatment

A The best course of action when the client has outbursts concerning treatments is to explain how the treatment is expected to help

A terminally ill client's husband tells the nurse, "I wish we had taken that trip to Europe last year. We just kept putting it off, and now I am furious that we did not go." The nurse interprets the husband's statement as indicating which stage of adaptation to dying? A. Anger B. Denial C. Bargaining D. Depression

A The client's husband is experiencing anger, much of which stems from feelings of quilt about not taking the trip

A 42-year-old female highway construction worker is concerned about her cancer risks. She has been married for 18 years, has two children, smokes one pack of cigarettes per day, and occasionally drinks one to two beers. She is 30lb overweight, eats fried fast food often, and rarely eats fresh fruits and vegetables. Her mother was diagnosed with breast cancer 2 years ago. Her father and an aunt both died of lung cancer. She had a basal cell carcinoma removed from her cheek 3 years earlier. What behavioral changes should the nurse coach this client to make to decrease her risk of cancer? (Select all that apply) A. Improve nutrition B. Decrease alcohol consumption C. Use sunscreen D. Stop smoking E. Lose weight F. Change her job to work inside

A,C,D,E The client is at increased risk for development of lung, skin, or breast cancer. Consequently, the client should improve nutrition, stop smoking, use sunscreen, and lose weight.

A middle-aged woman who is receiving radiation therapy tells the nurse that she feels inadequate as a wife and mother because she can no longer carry out her usual duties with the same energy as before. What recommendations should the nurse make to help the client cope with this situation? A. Suggest that she reassign all household chores to other members of the family B. Suggest that she prioritize her activities and ask for help from friends and family C. Suggest that she ignore the household chores during the crisis period D. Tell her not to worry so much because everyone gets a little tired at this phase of therapy

B Individuals who are experiencing fatigue need to prioritize their activities and ask for assistance from others

A client receiving radiation therapy for lung cancer is having difficulty sleeping. The nurse should: A. Suggest the client stop watching television before bed B. Assess the client's usual sleep patterns, amount of sleep, and bedtime rituals C. Tell the client sleeplessness is expected with radiation therapy D. Suggest that the client stop drinking coffee until the therapy is complete

B Since sleeplessness is often an adverse effect of radiation therapy, the nurse should first assess the client's usual sleep patterns, hours of sleep required before treatment, and usual bedtime routine.

When planning a culturally sensitive health education program, the nurse should: A. Locate the program at a facility that will not charge for uses. B. Integrate folk beliefs and traditions of the target population into the content. C. Prepare materials in the primary language of the program sponsor. D. Exclude community leaders from the dominant culture from initial planning efforts.

B Strategies to reach clients in all cultures should include incorporating the folk beliefs and traditions of the target population into the program

Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? (Select all that apply) A. Provide mouthwash with alcohol for oral rinsing. B. Use paper tape on fragile skin. C. Provide a soft toothbrush or oral sponge. D. Gently insert rectal suppositories. E. Avoid aspirin or aspirin-containing products. F. Avoid over-inflation of blood pressure cuffs. G. Pad sharp corners of furniture.

B,C,E,F,G Mouthwash should not include alcohol, because it has a drying action that leaves mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into rectal or vaginal cavity is not recommended. All other options are appropriate.

A client with a family history of cancer asks the nurse what the single most important risk factor is for cancer. Which risk factor should the nurse discuss? A. Family history B. Lifestyle choices C. Age D. Menopause or hormonal events

C Because more than 50% of the cancers occur in people who are older than age 65, the single most important factor in determining risk would be age

The nurse is assessing a client with anemia. In order to plan nursing care, the nurse should focus the assessment on which signs and symptoms? A. Decreased salivation B. Bradycardia C. Cold intolerance D. Nausea

C Cold intolerance may be associated with anemia because of the diminished oxygen supply to the peripheral circulation.

A client's husband expresses concern that his dying wife keeps saying, "I have to go to the store." Which statement by the nurse will be most effective in assisting the husband to understand the dying process? A. "Many dying clients are restless and can be treated with sedatives." B. "The client may be fighting death, and you should leave her alone." C. "Comments related to going somewhere or leaving on a trip are common in dying clients." D. "You can tell your wife that you will take her to the store."

C Mental changes and decreased LOC are common in the dying process, and the client may talk about travel, trips, or going somewhere.

A client undergoing chemotherapy has a white blood cell count of 2,300, hemoglobin of 9.8, platelet count of 80,000, and potassium of 3.8. Which finding should take priority? A. Blood pressure 136/88 B. Emesis of 90 mL C. Temperature 101 D. Urine output 40 mL/hr

C The client has a low white blood cell count from the chemotherapy and has a temperature. Signs and symptoms of infection may be diminished in a client receiving chemotherapy; therefore, the temperature elevation is significant.

An adult who recently had a right pneumonectomy for lung cancer is admitted to the oncology unit with dyspnea and fever. The nurse should: A. Place the client of the left side B. Position the client for postural drainage C. Provide education on deep-breathing exercises D. Instruct the client to maintain bed rest with bathroom priviledges

C The fever and dyspnea suggest a respiratory infection. Education on deep-breathing exercises or incentive spirometry, elevating the head of the bed, and getting out of bed to chair are necessary to promote lung expansion.

A daughter is concerned that her mother is in denial because when they discuss the diagnosis of breast cancer, the mother says that breast cancer is not that serious and then changes the subject. The nurse can tell the daughter that denial can be a healthy defense mechanism if it is used: A. To permit her mother to seek unconventional treatments B. When making decisions about her own care C. Alone and not in combination with other defense mechanisms D. To allow her mother to continue in her role as a mother

D Denial is a defense mechanism used to shut out a situation that is too frightening or threatening to tolerate. In this case, denial allows the client to vacillate between acceptance of the illness and its treatment and denial of the actual or potential seriousness of the disease.

A 36-year-old female client is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She has pain while swallowing and burning and tightness in her chest. The nurse should further assess the client for indications of: A. Hiatal hernia B. Stomatitis C. Radiation enteritis D. Esophagitis

D Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall

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

D Support groups are designed to educate clients and their families experiencing cancer about the disease and methods of coping positively with it

Which characteristic displayed by the wife of a 36-year-old man with pancreatic cancer suggests that she may be at risk for negative bereavement outcomes? A. She is preparing for her husband's death B. She has a high socioeconomic status C. She has strong family support D. She blames herself for her husband's cancer

D Variables that are most predictive of negative bereavement outcomes include anger and self-reproach, low socioeconomic status, lack of preparation for death, and lack of family support.

A 30-year-old male with HIV is diagnosed with Epstein-Barr virus. After 2 months, the virus is still active. Based upon the Epstein-Barr virus, which of the following cancers is most likely to develop in this patient? a. B cell lymphoma b. Kaposi sarcoma c. T cell leukemia d. T cell lipoma

a. B cell lymphoma

The nurse is teaching a 17-year-old client and the client's family about what to expect with highdose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? ■ 1. Fever. ■ 2. Chills. ■ 3. Tachycardia. ■ 4. Dyspnea.

1. Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.

Which of the following should be included in the teaching plan for a cancer client who is experiencing thrombocytopenia? Select all that apply. ■ 1. Use an electric razor. ■ 2. Use a soft-bristle toothbrush. ■ 3. Avoid frequent fl ossing for oral care. ■ 4. Include an over-the-counter nonsteroidal antiinfl ammatory (NSAID) daily for pain control. ■ 5. Monitor temperature daily. ■ 6. Report bleeding, such as nosebleed, petechiae, or melena, to a health care professional.

1, 2, 3, 6. Thrombocytopenia places the client at risk for bleeding. Therefore, electric razors will reduce the potential for skin nicks and bleeding. Oral hygiene should be provided with a soft toothbrush and with minimal friction to gently clean without trauma. Clients should be instructed to read labels on all over-the-counter medications and avoid medication such as aspirin or NSAIDs due to their effect on platelet adhesiveness. Clients should evaluate mucous membranes, skin, stools, or other sources of potential bleeding. Monitoring temperature may be an important part of assessment but is focused on neutropenia instead of the problem of thrombocytopenia.

The nurse is caring for a client with end stage cancer whose health status is declining. An order is written by the attending physician to withhold all fl uid, but the health care team cannot locate a family member or guardian. The nurse requests an ethics consultation. Which of the following is true of an ethics consultation? Select all that apply. ■ 1. Persons requesting an ethics consultation may do so without intimidation or fear of reprisal. ■ 2. Ethics consultations may prevent poor outcomes in cases involving ethical problems. ■ 3. The recommendations of ethics consultants are advisory only. ■ 4. Requests for ethics consultations may only be made by the physician or nurse. ■ 5. Ethics consultation is intended to provide legal advice on client care.

1, 2, 3. Ethics consultation seeks to facilitate communication and shared decision-making in client care. Ethics consultations also tend to increase knowledge of clinical ethics, to improve client care, and to prevent poor outcomes in cases involving ethical problems. Requests for ethics consultations can be made by any member of the health care team and by clients, family members, guardians, students, or others with a legitimate interest in the client. The recommendations of ethics consultants are advisory only; the ethics consultation process is intended to supplement and support existing departmental and institutional mechanisms for making decisions and resolving confl ict in clinical practice. Clinicians are encouraged to seek an ethics consultation when the client is incapacitated when no family member/s or guardian/s exist or can be found, or when the client's family members disagree about the ethically appropriate action to be taken. Ethics consultation is not intended or authorized to provide legal advice on client care. Persons requesting an ethics consultation may do so without intimidation or fear of reprisal.

When caring for a client with a central venous line, which of the following nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply. ■ 1. Verify patency of the line by the presence of a blood return at regular intervals. ■ 2. Inspect the insertion site for swelling, erythema, or drainage. ■ 3. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present. ■ 4. If unable to aspirate blood, reposition the client and encourage the client to cough. ■ 5. Contact the health care provider about verifying placement if the status is questionable.

1, 2, 4, 5. A major concern with I.V. administration of cytotoxic agents is vessel irritation or extravasation. The Oncology Nursing Society and hospital guidelines require frequent reevaluation of blood return when administering vesicant or nonvesicant chemotherapy due to the risk of extravasation. These guidelines apply to peripheral and central venous lines. The nurse should also assess the insertion site for signs of infi ltration, such as swelling and redness. In addition, central venous lines may be long-term venous access devices. Thus, diffi culty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via X-ray study to verify placement if the status is questionable and may require a declotting regimen (Abbokinase). The nurse should not administer any drug if the I.V. line is not open or does not have an adequate blood return.

A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife does which of the following? Select all that apply. ■ 1. Administers long-acting or sustained-release oral pain formula (OxyContin) regularly around-the-clock. ■ 2. Administers immediate-release medication (oxycodone) for breakthrough pain. ■ 3. Avoids long-acting opioids due to her concern about addiction. ■ 4. Uses music for distraction as well as heat or cold in combination with medications. ■ 5. Substitutes acetaminophen (Tylenol) to avoid tolerance to the medications. ■ 6. Has her husband use a pain rating scale to measure the effectiveness at reaching his individual pain goal.

1, 2, 4, 6. Guidelines (Agency for Healthcare Research and Quality and The Joint Commission) recommend use of scheduled long-acting opioids (MS Contin, OxyContin). Around-the-clock dosing is necessary to achieve a steady level of analgesia. Whatever the route or frequency, an order should be available for "breakthrough" pain medication to be administered in addition to the regularly scheduled medication. Oral drug administration is the route of choice for economy, safety, and ease of use. Even severe pain requiring high doses of opioids can be managed orally as long as the client can swallow medication and has a functioning gastrointestinal system. Tolerance occurs due to the need for increasing doses to achieve the same pain relief and will not be avoided with the use of Tylenol. Addiction is a complex condition in which the drug is used for psychological effect and not analgesia. Nurses need to educate families about the appropriate use of opioids and assure them that addiction is not a concern when managing cancer pain. Nonpharmacologic methods are useful as an adjunct to assist in pain control. Self-report is the best assessment of pain and is an individual response.

A client with colon cancer undergoes surgical removal of a segment of colon and creation of a sigmoid colostomy. What assessments by the nurse indicate the client is developing complications within the fi rst 24 hours? Select all that apply. ■ 1. Coarse breath sounds auscultated bilaterally at the bases. ■ 2. Dusky appearance of the stoma. ■ 3. No drainage in the ostomy appliance. ■ 4. Temperature greater than 101.2° F (38.5° C). ■ 5. Decreased bowel sounds.

1, 2, 4. Elevated temperature in the fi rst 24 hours along with coarse breath sounds may indicate a respiratory complication or the result of general anesthesia. Use of incentive spirometry and increasing activity would be key interventions. A healthy stoma will be beefy red. A dusky appearance of the stoma indicates decreased blood supply and is of concern. It is not uncommon to have decreased bowel sounds initially after gastrointestinal surgery. In addition, it usually will take time for the ostomy to function.

In an attempt to call public attention to the cancer survivor's needs, a bill of rights was put forth by the: ■ 1. American Cancer Society. ■ 2. National Coalition of Cancer Survivors. ■ 3. National Cancer Institute. ■ 4. National Hospice Organization.

1. The American Cancer Society wrote The Cancer Survivors' Bill of Rights. These rights address medical care, personal life adjustment, job opportunities, and insurance coverage.

The family of a hospitalized client demonstrates understanding of the teaching about advance directives when they make which of the following statements? Select all that apply. ■ 1. "Advance directives give instructions about future medical care and treatment." ■ 2. "If people are not capable of communicating their wishes, health care providers and family together can agree on measures or actions that will be taken." ■ 3. "Ethics experts agree that the family is the sole deciding factor when the client is competent." ■ 4. "Medical power-of-attorney gives primarily fi nancial access to the designee." ■ 5. "Medical power-of-attorney or durable powerof-attorney for health care is a document that lists who can make health care decisions should a person be unable to make an informed decision for himself or herself." ■ 6. "Advance directives give details about the client's past medical history."

1, 2, 5. In 1991, the Omnibus Reconciliation Act became effective. This Patient Self-Determination Act requires all institutions that participate in Medicare to provide information about and the right to initiate advance directives. Advance directives are written statements of person's wishes related to health care if they are unable to decide for themselves. These documents relate to current or future health care and not past medical history. Competent adults are responsible for their own health care decisions and their own right to accept or refuse treatment. Advance directives are used when the person cannot make the decision. Medical powerof- attorney is a term used to describe the person who makes health care decisions should someone be unable to make informed decisions for himself or herself. The focus is not primarily fi nancial access.

A client develops lymphedema after a left mastectomy with lymph node dissection. Which of the following should be included in the discharge teaching plan? Select all that apply. ■ 1. Do not allow blood pressures or blood draws in the affected arm. ■ 2. Avoid application of sunscreen on the left arm. ■ 3. Use an electric razor for shaving. ■ 4. Immobilize the left arm. ■ 5. Elevate the left arm. ■ 6. Perform hand pump exercises.

1, 3, 5, 6. Blood pressures or blood draws in the affected arm, sun exposure, trauma with a sharp razor, and immobilization increase the risk of lymphedema. Elevation of the arm and hand pump exercises promote lymph fl ow and reduce edema.

A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of possible lymphoma. Which statement made by the client demonstrates proper understanding of discharge teaching? Select all that apply. ■ 1. "I will take Tylenol for pain." ■ 2. "I do not need to inspect the puncture site." ■ 3. "I will not be able to play basketball for the next 2 days." ■ 4. "I will take aspirin if I have pain." ■ 5. "I can apply an ice pack or a cold compress to the puncture site."

1, 3, 5. Acetaminophen (Tylenol) is a safer analgesic than aspirin in order to avoid bleeding. Contact sports or trauma to the site should be avoided. Cool compresses should limit swelling and bruising. The puncture site should be inspected every 2 hours for bleeding or bruising during the fi rst 24 hours

The incidence and risk of cancer increase when smoking is combined with: ■ 1. Asbestos exposure and alcohol consumption. ■ 2. Ultraviolet radiation exposure and alcohol consumption. ■ 3. Asbestos exposure and ultraviolet radiation exposure. ■ 4. Alcohol consumption and human papillomavirus (HPV) infection.

1. Asbestos and alcohol, when combined with smoking, produce a synergistic effect and result in increased cancer risk and incidence. Ultraviolet radiation exposure is associated with skin cancer. HPV exposure is associated with cervical cancer. However, the risks of contracting these types of cancer are not markedly increased when combined with smoking

A client diagnosed with testicular cancer expresses concerns about fertility. The couple desires to eventually have a family and the nurse discusses the option of sperm banking. The nurse should inform the couple that sperm banking would need to be performed: ■ 1. Before treatment is started. ■ 2. Once the client is tolerating the treatment. ■ 3. Upon completion of treatment. ■ 4. When tumor markers drop to normal levels.

1. Because of the high risk of infertility with chemotherapy, pelvic irradiation, and retroperitoneal lymph node dissection that may follow an orchiectomy, cryopreservation of sperm is completed before treatment is started and should be discussed with the client.

A client with a diagnosis of cancer is frequently disruptive and challenges the nurse. This behavior is probably caused by: ■ 1. Uncertainty and an underlying fear of r ecurrence. ■ 2. The usual trajectory of a short-term illness. ■ 3. A history of a behavioral illness. ■ 4. The one-time crisis from learning of the diagnosis.

1. Cancer clients report that the lifelong fear of recurrence is one of the most disruptive aspects of the disease. The trajectory of the disease is unpredictable and can be intertwined with many short- and long-term illnesses related to cancer and the treatment modalities. A diagnosis of cancer challenges the individual and the family with a series of crises rather than a time-limited episode. There are no data to indicate that the client has an underlying behavioral disorder.

The nurse should expect single-donor platelets to be ordered for which of the following clients? ■ 1. A client who is receiving multiple platelet transfusions. ■ 2. A client who is defi cient in coagulation factors. ■ 3. A client whose platelet count is greater than 50,000/mm3 . ■ 4. A client who is refractory to random-donor platelets.

1. Clients who receive multiple platelet transfusions may form antibodies against many foreign antigens, thereby decreasing platelet response. Single-donor platelets are drawn from a single donor, decreasing the number of possible foreign antigens and increasing platelet response for long-term therapy. Platelets do not contain coagulation factors in clinically signifi cant amounts. Clients with a platelet count greater than 50,000/ mm3 are not at risk for bleeding. Human leukocyte antigen-matched platelets are used when clients become refractory to single-donor and randomdonor platelets.

The nurse is teaching the client and family how to manage possible nausea and vomiting at home. The nurse should include information about: ■ 1. Eating frequent, small meals throughout the day. ■ 2. Eating three normal meals a day. ■ 3. Eating only cold foods with no odor. ■ 4. Limiting the amount of fl uid intake.

1. Dietary suggestions to reduce adverse effects of cancer and cancer therapies include a soft, bland diet low in fat and sugar. Frequent, small meals are usually better tolerated. It is not necessary to restrict the diet to cold foods. Fluid intake should be encouraged to avoid dehydration.

A client with cancer verbalizes that he is afraid he won't be able to cope with all the issues that will arise. The nurse can best support the coping behaviors of a client with cancer by: ■ 1. Helping the client identify available resources. ■ 2. Encouraging compliance with treatment regimens. ■ 3. Relieving the client of decision making as much as possible. ■ 4. Assisting the client to prepare for adverse treatment effects.

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

A 62-year-old female is taking long-acting morphine 120 mg every 12 hours for pain from metastatic breast cancer. She can have 20 mg of immediate-release morphine every 3 to 4 hours as needed for breakthrough pain. The physician should be notifi ed if the client uses more than how many breakthrough doses of morphine in 24 hours? ■ 1. Seven. ■ 2. Four. ■ 3. Two. ■ 4. One.

1. If the maximum dose specifi ed by the physician's order is required every 3 to 4 hours for break-through pain, the physician should be notifi ed to increase the long-acting medication or rotate to another type of opioid. Around-the-clock dosing is mandatory to achieve a steady state of analgesia. The rescue dose for breakthrough pain is administered over and above the regularly scheduled medication. If three to four analgesic doses are required every 24 hours, the sustained-release around-theclock dose should be increased to include the amount used for previous breakthrough pain while maintaining a dose for future breakthrough pain.

A nurse is assessing a client with bone cancer pain. Which of the following components of a thorough pain assessment is most signifi cant for this client? ■ 1. Intensity. ■ 2. Cause. ■ 3. Aggravating factors. ■ 4. Location.

1. Intensity is indicative of the severity of pain and is important for evaluating the effi cacy of pain management. The cause and location of the pain cannot be managed but the intensity of the pain can be controlled. The nurse and client can collaborate to reduce aggravating factors; however, the goal will ultimately be to reduce the intensity of the pain.

During the initial stage of adaptation to the diagnosis of cancer and its treatment, the nurse can facilitate the client's adaptation by: ■ 1. Encouraging the client to maintain her usual role. ■ 2. Facilitating family-related disagreements and confl icts. ■ 3. Supporting the client in her use of denial as a coping strategy. ■ 4. Arranging transportation and child care on treatment days.

1. Maintaining role function has been found to be a supportive source of normalcy and positive self-esteem for the client and family during the cancer experience. Facilitating family-related disagreements and confl icts is not the nurse's role. Supporting the client in her use of denial as a coping strategy will not help facilitate the client's adaptation to the diagnosis. Arranging transportation and child care on treatment days may be helpful but does not necessarily facilitate adaptation to the diagnosis.

A 29-year-old woman is concerned about her personal risk factors for malignant melanoma. She is upset because her 49-year-old sister was recently diagnosed with the disease. After gathering information about the client's history of sun exposure, the nurse's best response would be to explain that: ■ 1. Some melanomas have a familial component and she should seek medical advice. ■ 2. Her personal risk is low because most melanomas occur at age 60 or later. ■ 3. Her personal risk is low because melanoma does not have a familial component. ■ 4. She should not worry because she did not experience severe sunburn as a child.

1. Malignant melanoma may have a familial basis, especially in families with dysplastic nevi syndrome. First-degree relatives should be monitored closely. Malignant melanoma occurs most often in the 20- to 45-year-old age-group. Severe sunburn as a child does increase the risk; however, this client is at increased risk because of her family history.

The nursing team on an oncology unit consists of a registered nurse (RN), a licensed vocational nurse (LVN-LPN), and unlicensed assistive personnel (UAP). Which client should be assigned to the registered nurse? ■ 1. A 52-year-old client with lung cancer admitted for acute dyspnea. ■ 2. A 45-year-old client receiving tube feedings. ■ 3. A 28-year-old client being evaluated for a bone marrow transplant. ■ 4. A 65-year-old client diagnosed with endometrial cancer who underwent an abdominal hysterectomy 3 days ago.

1. Ongoing assessment by the RN is required to evaluate the client with dyspnea to monitor for potential deterioration of the respiratory status. If the RN is the care provider, she will have greater interaction with the individual client. The RN is responsible for assessment of all the clients. The other clients would not be considered unstable, and maintaining a patent airway is always the priority in providing care. Care for the other clients could be assigned safely, according to the abilities of the LVNLPN and UAP.

Carcinogenesis is irreversible in which of the following stages? ■ 1. Progression stage. ■ 2. Promotion stage. ■ 3. Initiation stage. ■ 4. Regression stage.

1. Progression is the change in a tumor from the preneoplastic state or low degree of malignancy to a rapidly growing tumor; it cannot be reversed. Promotion is reversible. Initiation is at fi rst reversible (through repair of damaged DNA) and later irreversible. Regression is not a recognized stage of carcinogenesis.

The young sister of a client with leukemia asks, "Can you check my blood? When my sister got the measles, so did I. And I think I have this, too." Which of the following by the nurse would be inappropriate? ■ 1. Asking the client's physician to take a sample of the sister's blood. ■ 2. Explaining to the sister that leukemia is not a communicable disease. ■ 3. Discussing the sister's concern with her parents. ■ 4. Telling the sister's parents about a group for siblings of clients with terminal illness.

1. Taking a blood sample is an unnecessary, invasive procedure that would not directly address the sister's fear. Leukemia is not considered a communicable disease. Providing an explanation and alerting the parents to the sibling's concern and the resources available to assist siblings to deal with the terminal illness are all appropriate interventions.

When an oncologist is teaching about how radiation induces genomic instability, which of the following should the oncologist discuss? a. Increasing hypersensitivity b. Facilitating new mutations c. Promoting cell death d. Enhancing mitosis

b. Facilitating new mutations Rationale: Radiation induces genomic instability because it facilitates new mutations.

A 62-year-old woman thinks her husband's rehabilitation needs have been unmet by his employer after his diagnosis and treatment of colon cancer. The nurse should give her information about: ■ 1. The Americans With Disabilities Act of 1990. ■ 2. Title V of the Rehabilitation Act of 1973. ■ 3. The Civil Rights Act of 1964. ■ 4. The Patient Self-Determination Act of 1991.

1. The Americans with Disabilities Act of 1990 requires equal opportunity in selection, testing, and hiring of qualifi ed applicants with disabilities. Under this act, anyone who has had cancer is considered disabled. This law prohibits discrimination against workers with disabilities and is similar to the Civil Rights Act of 1964 and Title V of the Rehabilitation Act of 1973. The Patient SelfDetermination Act addresses the rights of clients in regard to making health care decisions and the use of advance directives.

A 32-year-old teacher is concerned that she will lose her job if she requests a leave of absence to care for her father who is getting daily treatment for colon cancer in a city 300 miles away. Which legislative measure will likely protect her job during an extended illness? ■ 1. Family Leave Act of 1993. ■ 2. Americans with Disabilities Act of 1990. ■ 3. Medicare Coverage for Catastrophic Illness Act of 1988. ■ 4. Rehabilitation Act of 1973.

1. The Family Leave Act of 1993 ensures that family caregivers who must take a leave of absence or decrease their hours during the treatment or recovery phase of an illness will not lose their jobs. The Americans with Disabilities Act of 1990 prohibits employment discrimination against persons with disabilities or those who are perceived to have disabilities; it has an indirect economic impact for cancer victims and their families. The Medicare Coverage for Catastrophic Illness Act of 1988 provides increased coverage for clients with a catastrophic illness. The Rehabilitation Act of 1973 prohibits discrimination on the basis of handicap under any program or activity receiving federal fi nancial assistance.

A client who is in the end-stages of cancer is increasingly prone to outbursts concerning chemotherapy treatments. Which of the following approaches by the nurse would likely be most helpful in gaining the client's cooperation? ■ 1. Telling the client how the treatment can be expected to help. ■ 2. Describing the probable effect on that missing a treatment would have. ■ 3. Saying "be a good client" and not make the treatment any harder for yourself. ■ 4. Promising to give a backrub when the treatment is completed.

1. The best course of action when the client has outbursts concerning treatments is to explain how the treatment is expected to help. Describing the effect if the client misses a treatment is a negative approach and may be threatening to the client. The client is likely to feel angry if told to be a "good client" during treatments. Offering to give the client a backrub does not give information to the client and may negatively reinforce the behavior.

A terminally ill client's husband tells the nurse, "I wish we had taken that trip to Europe last year. We just kept putting it off, and now I'm furious that we didn't go." The nurse interprets the husband's statement as indicating which of the following stages of adaptation to dying? ■ 1. Anger. ■ 2. Denial. ■ 3. Bargaining. ■ 4. Depression.

1. The client's husband is experiencing anger, much of which stems from feelings of guilt about not taking the trip. During the stage of denial, the husband is more likely to deny the client's diagnosis and prognosis. During the stage of bargaining, the husband would offer to do certain things in exchange for more time before the client dies. In the stage of depression, the husband is likely to make few or no comments and to act dejected.

Assessment of a client taking a nonsteroidal anti-infl ammatory drug (NSAID) for pain management should include specifi c questions regarding which of the following systems? ■ 1. Gastrointestinal. ■ 2. Renal. ■ 3. Pulmonary. ■ 4. Cardiac.

1. The most common toxicities from NSAIDs are gastrointestinal disorders (nausea, epigastric pain, ulcers, bleeding, diarrhea, and constipation). Renal dysfunction, pulmonary complications, and cardiovascular complications from NSAIDs are much less common.

A nurse is caring for a client 24 hours after he has undergone an abdominal-perineal resection for a bowel tumor. The client's wife asks if she can bring him some of his favorite home-cooked Italian minestrone soup. What would be an appropriate action by the nurse? ■ 1. Auscultate for bowel sounds. ■ 2. Ask the client if he feels hunger or gas pains. ■ 3. Consult the dietician. ■ 4. Encourage the wife to bring the soup.

1. The nurse should perform a thorough assessment of the abdomen and auscultate for bowel sounds in all four quadrants. Clients who have gastrointestinal surgery may have decreased peristalsis for several days after surgery. The nurse should check the abdomen for distention and check with the client and the medical record regarding the passage of fl atus or stool. Consulting a dietician would be inappropriate because the client must be kept on nothing-by-mouth status until bowel sounds are present. The nurse should explain to the wife that it is too soon after surgery for her husband to eat.

A client who is dying of acquired immunodefi ciency syndrome (AIDS) is admitted to the inpatient psychiatric unit because he attempted suicide. His close friend recently died of AIDS. The client begins to talk about his feelings related to his illness and the loss of his friend. He begins to cry. Which of the following responses by the nurse would be most appropriate? ■ 1. Give the client some tissues and tell him it is okay to cry. ■ 2. Tell the client to stop crying and that everything will be okay. ■ 3. Sort the client's mail to distract the client. ■ 4. Change the subject.

1. The nurse would give the client a tissue and tell him it's okay to cry to convey acceptance and empathy. He needs to know that it is natural to have tremendous feelings of loss and sadness. Telling the client to stop crying, busying oneself in the client's room, and changing the subject are not helpful to the client because they ignore his needs and inhibit the expression of emotion.

A nurse is assessing a female who is receiving her second administration of chemotherapy for breast cancer. When obtaining this client's health history, what is the most important information the nurse should obtain? ■ 1. "Has your hair been falling out in clumps?" ■ 2. "Have you had nausea or vomiting?" ■ 3. "Have you been sleeping at night?" ■ 4. "Do you have your usual energy level?"

2. Chemotherapy agents typically cause nausea and vomiting when not controlled by antiemetic drugs. Antineoplastic drugs attack rapidly growing normal cells, such as in the gastrointestinal tract. These drugs also stimulate the vomiting center in the brain. Hair loss, loss of energy, and sleep are important aspects of the health history, but not as critical as the potential for dehydration and electrolyte imbalance caused by nausea and vomiting.

A client with bladder cancer has lost an estimated 500 mL blood in the urine. The client's hemoglobin is 8.0 g/dL, and the physician orders a unit of packed blood cells. To administer the packed red blood cells, the nurse should: ■ 1. Attach the packed cells to the existing 19G I.V. of normal saline solution using Y tubing. ■ 2. Start an additional 22G I.V. site because the packed blood cells must be given in a separate line. ■ 3. Attach the packed blood cells to the existing 22G I.V. of 5% dextrose using Y tubing. ■ 4. Start an additional I.V. access device with a 22G Intracath.

1. The packed cells should be administered using a central catheter or 19G needle. Y tubing is used and the normal saline solution is used to keep the vein open when the blood transfusion is complete. Blood is not compatible with dextrose because dextrose may cause blood coagulation. Blood products should be given with normal saline solution. A blood fi lter must be used for all blood products to fi lter out sediment from stored blood products. It is not necessary to add another I.V. access.

A client informs the nurse that she is using an herbal therapy while receiving chemotherapy. Which of the following actions should the nurse take? ■ 1. Determine what substances the client is using and make sure that the physician is aware of all therapies the client is using. ■ 2. Guide the client in the decision-making process to select either Western or alternative medicine. ■ 3. Encourage the client to seek alternative modalities that do not require the ingestion of substances. ■ 4. Recommend that the client stop using the alternative medicines immediately.

1. The role of the nurse is to assess what substances or medications the client is using and to document and inform other members of the health care team. It is very important to encourage the client to keep the physician informed of all therapeutic agents, medications, and supplements she is using, to avoid adverse interactions. It is not appropriate for the nurse to suggest that the client choose either Western or alternative therapies or to discourage the client's use of alternative therapies. The nurse should remain objective about the client's treatment choices and respect her autonomy.

A 58-year-old male is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following? ■ 1. "Chemotherapy affects all rapidly dividing cells." ■ 2. "The molecular structure of the DNA is altered." ■ 3. "Cancer cells are susceptible to drug toxins." ■ 4. "Chemotherapy encourages cancer cells to divide."

1. There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells-both cancerous and noncancerous. Cancer cells are characterized by rapid cell division. Chemotherapy slows cell division. Not all chemotherapeutic agents affect molecular structure. All cells are susceptible to drug toxins, but not all chemotherapeutic agents are toxins.

A client with colon cancer had a left hemicolectomy 3 weeks previously. The client is still having diffi culty maintaining an adequate oral intake to meet metabolic needs for optimal healing. Which of the following nutritional support methods would be most appropriate? ■ 1. Total parenteral nutrition through a central catheter. ■ 2. I.V. infusion of dextrose. ■ 3. Nasogastric feeding tube with protein supplement. ■ 4. Jejunostomy for high caloric feedings.

1. Total parenteral nutrition solutions supply the body with suffi cient amounts of dextrose, amino acids, fats, vitamins, and minerals to meet metabolic needs. Clients who are unable to tolerate adequate quantities of foods and fl uids and those who have had extensive bowel surgery may not be candidates for enteral feedings. The nurse would anticipate total parenteral nutrition via central catheter to promote wound healing. I.V. dextrose does not supply all the nutrients required to promote wound healing.

What instructions should the nurse provide to a client who develops cellulitis in the right arm after a right modifi ed radical mastectomy? ■ 1. Antibiotics will need to be taken for 1 to 2 weeks. ■ 2. Arm exercises will get rid of the cellulitis. ■ 3. Ice pack should be applied to the affected area for 20 minute periods to reduce swelling. ■ 4. The right extremity should be lowered to improve blood fl ow to the forearm.

1. Treatment for cellulitis includes oral or intravenous antibiotics for 1 to 2 weeks, elevation of the affected extremity, and application of warm, moist packs to the site. Arm exercises help to reduce swelling, but do not treat the infection.

Which of the following philosophies should the nurse most likely integrate into the plan of care for a client and family to help them best cope during the fi nal stages of the client's illness? ■ 1. Living each day as it comes as fully as possible. ■ 2. Reliving the pleasant memories of days gone by. ■ 3. Expecting the worst and being grateful when it does not happen. ■ 4. Planning ahead for the remaining good times that will be spent together.

1. When supporting the friends or family of a terminally ill client, it is best to focus on the present. This can be accomplished by living each day to its fullest. Friends and families also want to know what to expect and want someone to listen to them as they express grief over the approaching death. Focusing on the past can interfere with enjoying the present. Expecting the worst interferes with focusing on day-to-day positive experiences. Planning ahead is inappropriate because of uncertainty when the length of life is unknown.

A 79-year-old male client is admitted again for heart failure and kidney failure. After completing his admission, the nurse is talking with the client's wife, who expresses several concerns. She says, "I know he doesn't want to die in a hospital, but it is so hard for me to take care of him at home. He said he doesn't want any more treatment, but I'm not ready to let him go. We have so many arrangements to decide before he dies." Which of the following statements by the nurse to the client's wife would be most appropriate? Select all that apply. ■ 1. "He's not going to die that soon judging by his current symptoms." ■ 2. "What are your fears about your husband dying?" ■ 3. "I can imagine that it is hard for you to care for him at home." ■ 4. "What do you and your husband know about advance directives?" ■ 5. "We can discuss types of hospice and home care available." ■ 6. "What kind of arrangements do you think need to be made before he dies?"

2, 3, 4, 5, 6. With serious, chronic, and terminal illnesses, it is important to help clients and families address fears, diffi culties with home care, advance directives, hospice and home care options, and fi nal arrangements. Predicting the length of life for this client is not appropriate at admission.

A patient asks why indoor pollution is worse than outdoor pollution. How should the nurse respond? Indoor pollution is considered worse than outdoor pollution because of cigarette smoke and: a. Fireplace wood smoke b. Radon c. Benzene d. Chlorine

b. Radon Rationale: Indoor pollution is related to cigarette smoke and radon.

After completing the nursing assessment for a client and family entering the palliative care program, the nurse should develop a teaching plan that includes an understanding of which of the following outcomes? Select all that apply. ■ 1. Alteration in the family's usual coping strategies. ■ 2. Achievement of a dignifi ed and respectful death. ■ 3. Improvement in the client's quality of life. ■ 4. Provision of comfort during the dying process. ■ 5. Provision of support for client and family. ■ 6. Advocation for prolonging life while curing the disease

2, 3, 4, 5. End-of-life care is the term currently used for issues related to death and dying. End-oflife care focuses on physical and psychosocial needs at the end of life for the client and client's family. Palliative care is health care aimed at symptom management rather than curative treatment for diseases. Goals would include providing comfort and support for the client and family and improving the client's quality of life. Grief counseling is a component and efforts would be to enhance the coping of all involved and not to alter usual coping methods.

A 56-year-old female with lung cancer is undergoing a thoracentesis. Which of the following outcomes of the procedure are expected? Select all that apply. ■ 1. Treatment of recurrent malignant effusion. ■ 2. Diagnosis of underlying disease. ■ 3. Palliation of symptoms. ■ 4. Relief of acute respiratory distress. ■ 5. Removal of the cancer cells.

2, 3, 4. Thoracentesis is usually successful for diagnosis of underlying disease, palliation of symptoms, and treating the acute respiratory distress; alleviation of the symptoms and distress is usually short-term. The thoracentesis is not used as a treatment for recurrent pleural effusion because the fl uid accumulates rapidly. Thoracentesis does not remove cancer cells.

A 68-year-old male has been receiving monthly doses of chemotherapy for treatment of stage III colon cancer. He comes to the clinic for his fourth monthly dose. Which laboratory result(s) should be reported to the oncologist before the next dose of chemotherapy is administered? Select all that apply. ■ 1. Hemoglobin of 14.5 g/dL. ■ 2. Platelet count of 40,000/mm3 . ■ 3. Blood urea nitrogen (BUN) level of 12 mg/dL. ■ 4. White blood cell count of 2,300/mm3 . ■ 5. Temperature of 101.2° F (38.4° C). ■ 6. Urine specifi c gravity of 1.020.

2, 4, 5. Chemotherapy causes bone marrow suppression and risk of infection. A platelet count of 40,000/mm3 and a white blood cell count of 2,300/mm3 are low. A temperature of 101.2° F (38.4° C) is high and could indicate an infection. Further assessment and examination should be performed to rule out infection. The BUN, hemoglobin, and specifi c gravity values are normal.

A client has undergone surgical resection for lung cancer. Which of the following nursing interventions will promote adaptation and rehabilitation? ■ 1. Arranging a visit from a member of the American Cancer Society Lost Chord Club. ■ 2. Planning a progressive activity regimen with the client. ■ 3. Teaching tracheostomy care. ■ 4. Planning a vigorous exercise program.

2. A progressive activity regimen may be prescribed to increase pulmonary function after surgical lung resection. Rehabilitation should include walking and some stair climbing as tolerated. Vigorous exercise is usually not recommended initially. Joining the Lost Chord Club and learning tracheostomy care are appropriate for the client who has undergone a laryngectomy.

When talking with the nurse, the brother of a client with leukemia says, "We used to play pretty rough games together. Maybe some of the bruises he got when I tackled him caused this." Which of the following would be the nurse's best response? ■ 1. "Don't feel guilty. You didn't cause your brother's illness." ■ 2. "I can see you're worried. Let's talk about how people get leukemia." ■ 3. "Here is some information about leukemia for you to read." ■ 4. "Lots of people worry about things like this. It isn't your fault."

2. A response that acknowledges the brother's concern and provides him with information is most helpful. Therefore, telling the brother that the nurse sees that he is worried and then following this up with a discussion about leukemia is most appropriate. Providing reassurance or information without acknowledging the expressed concern is not as helpful as acknowledging the concern and providing the information. Although acknowledging his worry is appropriate, more importantly, the brother needs factual information about the disease.

A 72-year-old client with cancer needs assistance with paying hospital bills. The nurse should refer the client to a: ■ 1. Bank representative. ■ 2. Social worker. ■ 3. Loan offi cer. ■ 4. Representative of the hospital billing department.

2. A social worker can provide information for supportive services and can help the client with fi nancial concerns. A bank representative, loan offi cer, or someone from the hospital billing department may be needed; however, it is most appropriate for the social worker to fi rst assess the client's needs.

A 40-year-old female is losing most of her hair as a result of chemotherapy. Which of the following statements best explains chemotherapyinduced alopecia? ■ 1. "The new growth of hair will be gray." ■ 2. "The hair loss is temporary." ■ 3. "New hair growth will always be the same texture and color as it was before chemotherapy." ■ 4. "The client should avoid use of wigs when possible."

2. Alopecia from chemotherapy is temporary. The new hair will not be necessarily gray, but the texture and color of new hair growth may be different. Clients who will be receiving chemotherapy should be encouraged to purchase a wig while they still have hair so that they can match the color and texture of their hair. Loss of hair, or alopecia, is a serious threat to self-esteem and should be addressed quickly before treatment.

A client undergoing chemotherapy tells the nurse, "I do not want to get out of bed in the morning because I am so tired." The nursing plan of care should include: ■ 1. Education on the use of Neupogen (fi lgrastim). ■ 2. Individually tailored exercise program. ■ 3. Weight lifting when not experiencing fatigue. ■ 4. Bed rest until chemotherapy is completed.

2. An individualized exercise program will increase stamina and endurance. Weight lifting may be too vigorous. Neupogen is used to increase white blood cells and is not applicable in this situation. Decreased hemoglobin and hematocrit predisposes the client to fatigue due to decreased oxygen availability. Bed rest causes muscle atrophy, adding to fatigue, and promotes DVT formation.

A nurse is making follow-up phone calls to clients being treated for cancer. Place the options below in the order of priority that the nurse should return the calls. 1. The client receiving chemotherapy who complains of a loss of appetite. 2. The client who underwent a mastectomy 2 weeks ago who called for information on the Reach for Recovery program. 3. The client receiving spinal radiation for bone cancer metastases who complains of urinary incontinence. 4. The client with colon cancer who has questions about a high-fi ber diet.

3142

A nurse is caring for a client who is undergoing chemotherapy. Current laboratory values are noted on the chart. Which action would be most appropriate for the nurse to implement? ■ 1. Wearing a protective gown and particulate respiratory mask when completing treatments. ■ 2. Washing hands before and after entering the room. ■ 3. Restricting visitors. ■ 4. Contacting the physician for an order for hematopoietic factors such as erythropoietin (Epogen, Procrit).

2. Chemotherapy causes myelosuppression with a decrease in red blood cells (RBCs), WBCs, and platelets. This client's data demonstrate neutropenia, placing the client at risk for infection. An ANC of 500 to 1,000/mm3 indicates a moderate risk of infection; an ANC of less than 500/mm3 indicates severe neutropenia and a high risk of infection. When the WBC count is low and immature WBCs are present, normal phagocytosis is impaired. Precautions are implemented to protect the client from life-threatening infections. These may be instituted when ANC is less than 1,000/mm3 . Hand washing is the single best way to avoid the spread of infection. It is not necessary to wear a gown and mask to take care of this client. It is also not necessary to restrict visitors; however, the client's visitors should be screened to avoid exposing the client to possible infections. Epogen or Procrit are used for stimulating RBCs, not WBCs. Granulocyte colony-stimulating factors or granulocyte macrophage colony- stimulating factors are useful for treating neutropenia.

A client suspects that he will not live. However, others talk about only pleasant matters with him and maintain a persistently cheerful facade around him. The nurse anticipates that the client will most likely feel which of the following as a result of such behavior? ■ 1. Relief. ■ 2. Isolation. ■ 3. Hopefulness. ■ 4. Independence.

2. Children are aware of and show anxieties about death at an earlier age than was once thought, and they recognize false cheerfulness. They tend to experience isolation and loneliness when those around them are trying to hide or mask the truth. They are then left to face the realities of death alone. Children do not experience relief or hopefulness when others are falsely cheerful. Independence is promoted by offering the child realistic choices about care at the end of life.

Which of the following is an environmental factor that increases the risk of cancer? ■ 1. Gender. ■ 2. Nutrition. ■ 3. Immunologic status. ■ 4. Age.

2. Environmental factors include place of residence, nutrition, occupation, personal habits, iatrogenic factors, and physical environment. Gender, immunologic status, and age are individual factors.

A 42-year-old female is interested in making dietary changes to reduce her risk of colon cancer. What dietary selections should the nurse suggest? ■ 1. Croissant, granola and peanut butter squares, whole milk. ■ 2. Bran muffi n, skim milk, stir-fried broccoli. ■ 3. Granola, bagel with cream cheese, caulifl ower salad. ■ 4. Oatmeal, raisin cookies, baked potato with sour cream, turkey sandwich.

2. High-fi ber, low-fat diets are recommended to reduce the risk of colon cancer. Stir-frying, poaching, steaming, and broiling are all low-fat methods to prepare foods. Croissants are made of refi ned fl our. They are also high in fat, as are peanut butter squares and whole milk, granola, cream cheese, and sour cream.

The nurse is assessing a client with chronic pain. Which of the following is an expected response? ■ 1. Elevated vital signs, physical inactivity, facial grimacing, and periods of anxiety. ■ 2. Normal vital signs, physical inactivity, and normal facial expressions. ■ 3. Normal vital signs, normal facial expressions, and moaning. ■ 4. Elevated vital signs, grimacing, and depression.

2. In the client with chronic pain, physiologic adaptation results in minimal changes in behavior and vital signs. Elevated vital signs, grimacing, and moaning are characteristic responses to acute pain.

A 56-year-old female who is receiving radiation therapy tells the nurse that she feels inadequate as a wife and mother because she can no longer carry out her usual duties with the same energy as before. What recommendations should the nurse make to help the client cope with this situation? ■ 1. Suggest that she reassign all household chores to other members of the family. ■ 2. Suggest that she prioritize her activities and ask for help from friends and family. ■ 3. Suggest that she ignore the household chores during the crisis period. ■ 4. Tell her not to worry so much because everyone gets a little tired at this phase of the therapy.

2. Individuals who are experiencing fatigue need to prioritize their activities and ask for assistance from others. It is best not to take away all of the client's activities because her role as wife and mother is obviously important to her and to her sense of self-worth. Suggesting that she ignore the household chores or telling her not to worry because everyone gets tired disregards the client's feelings and is not appropriate.

A 36-year-old male with lymphoma is assessing a client who reports distress 9 days after chemotherapy. Because of the risk for septic shock, the nurse should assess the client for which cluster of symptoms? ■ 1. Flushing, decreased oxygen saturation, mild hypotension. ■ 2. Low-grade fever, chills, tachycardia. ■ 3. Elevated temperature, oliguria, hypotension. ■ 4. High-grade fever, normal blood pressure, increased respirations.

2. Nine days after chemotherapy, one would expect the client to be immunocompromised. The clinical signs and symptoms of shock refl ect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, tachycardia, and chills may be early signs of shock. The client with signs and symptoms of impending septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased

A 57-year-old client has diffi culty with mobility after cancer treatment therapies and states, "Why should I bother trying to get better? It doesn't seem to make any difference what I do." The nurse responds by helping the client establish reasonable activity goals, choose her own foods from the menu, and make choices about her daily activities. These interventions represent the nurse's attempt to address which of the following nursing diagnoses? ■ 1. Ineffective coping. ■ 2. Powerlessness. ■ 3. Risk prone health behavior. ■ 4. Complicated grieving.

2. Powerlessness is a subjective experience of helplessness and apathy that can be threatening to one's competency and result in increased dependence on others. Effective nursing interventions will provide opportunities for the client to be involved in decision making and to regain a sense of control. Ineffective coping may also be a response to altered mobility, but the nursing interventions would be directed toward enhancing coping skills. Impaired adjustment is characterized by statements or actions suggesting that the client has not accepted the change in her health status. Complicated grieving is characterized by sadness, reliving past experiences, and expressions of distress about the loss.

A 36-year-old female is scheduled to receive external radiation therapy and a cesium implant for cancer of the cervix. Which of the following statements would be most accurate to include in the teaching plan about the potential effects of radiation therapy on sexuality? ■ 1. "You can have sexual intercourse while the implant is in place." ■ 2. "You may notice some vaginal dryness after treatment is completed." ■ 3. "You may notice some vaginal relaxation after treatment is completed." ■ 4. "You will continue to have normal menstrual periods during treatment."

2. Radiation fi elds that include the ovaries usually result in premature menopause. Vaginal dryness will occur without estrogen replacement. There should be no sexual intercourse while the implant is in place. Cesium is a radioactive isotope used for therapeutic irradiation of cancerous tissue. There is no documentation to support vaginal relaxation after treatment. Because the client will have premature menopause, she will not have normal menstrual periods.

To promote comfort and optimal respiratory expansion for a client with chronic obstructive pulmonary disease during sexual intimacy, the nurse can suggest that the couple: ■ 1. Use a waterbed. ■ 2. Use pillows to raise the affected partner's head and upper torso. ■ 3. Have the affected partner assume a dependent position. ■ 4. Limit the duration of the sexual activity.

2. Raising the upper torso for the affected partner facilitates respiratory function. The use of a waterbed may be helpful for the sensation of movement but it does not promote respiratory expansion. A dependent position may compromise respiratory expansion, even though energy may be conserved. Duration of sexual activity is not necessarily related to exertion.

The development of a culturally sensitive health education program for the socioeconomically disadvantaged requires the nurse to: ■ 1. Locate the program at an existing government facility. ■ 2. Integrate folk beliefs and traditions into the content. ■ 3. Prepare materials in the primary language of the program sponsor. ■ 4. Exclude community leaders from initial planning efforts.

2. Strategies to reach the socioeconomically disadvantaged should include incorporating the folk beliefs and traditions of the target population into the program. Identifi cation of a centrally located building with available access by the target population, use of materials in the native or primary language of the target population, and involvement by the community leaders will also help the program succeed.

Which of the following statements is most accurate regarding the long-term toxic effects of cancer treatments on the immune system? ■ 1. Clients with persistent immunologic abnormalities after treatment are at a much greater risk for infection than clients with a history of splenectomy. ■ 2. The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. ■ 3. Long-term immunologic effects have been studied only in clients with breast and lung cancer. ■ 4. The helper T cells recover more rapidly than the suppressor T cells, which results in positive helper cell balance that can last 5 years.

2. Studies of long-term immunologic effects in clients treated for leukemia, Hodgkin's disease, and breast cancer reveal that combination treatments of chemotherapy and radiation can cause overall bone marrow suppression, decreased leukocyte counts, and profound immunosuppression. Persistent and severe immunologic impairment may follow radiation and chemotherapy (especially multiagent therapy). There is no evidence of greater risk of infection in clients with persistent immunologic abnormalities. Suppressor T cells recover more rapidly than the helper T cells.

A registered nurse (RN) instructs the unlicensed assistive personnel (UAP) to check the urine intake and output (I&O) on clients on the oncology unit at the end of the 8-hour shift. It is important for the nurse to instruct the UAP to do what? ■ 1. Ask the clients if they are thirsty when calculating the I&O. ■ 2. Report back to the nurse immediately if any client has an output less than 240 mL. ■ 3. Document the I&O results on the medical records. ■ 4. Write the I&O results down for the nurse to give report to the next shift.

2. The RN is responsible for describing to the UAP when to report to the RN a result that indicates a potential client problem with dehydration. The RN must assess and interpret results, but must give concrete feedback to the UAP on what is an expected situation or a specifi c result to report back to the RN. Urine output should be at least 30 mL/hour, or 240 mL over the 8-hour shift. Dehydrated clients may be thirsty and the UAP can ask if the client is thirsty and offer water if permitted. However, because urine output is the critical indicator of dehydration, the UAP should document I&O and give results outside the normal range to the nurse. The nurse is specifi - cally assessing dehydration and should request to receive this information.

A 28-year-old client with cancer is afraid of experiencing a febrile reaction associated with blood transfusions. He asks the nurse if this will happen to him. The nurse's best response is which of the following? ■ 1. "Febrile reactions are caused when antibodies on the surface of blood cells in the transfusion are directed against antigens of the recipient." ■ 2. "Febrile reactions can usually be prevented by administering antipyretics and antihistamines before the start of the transfusion." ■ 3. "Febrile reactions are rarely immune-mediated reactions and can be a sign of hemolytic transfusion." ■ 4. "Febrile reactions primarily occur within 15 minutes after initiation of the transfusion and can occur during the blood transfusion."

2. The administration of antipyretics and antihistamines before initiation of the transfusion in the frequently transfused client can decrease the incidence of febrile reactions. Febrile reactions are immune-mediated and are caused by antibodies in the recipient that are directed against antigens present on the granulocytes, platelets, and lymphocytes in the transfused component. They are the most common transfusion reactions and may occur with onset, during transfusion, or hours after transfusion is completed.

A 58-year-old client with pancreatic cancer, who has been bed-bound for 3 weeks, has just returned from having a left subclavian, long-term, tunneled catheter inserted for administration of analgesics. The nurse has not yet received radiographic results for confi rmation of placement. The client becomes restless and dyspneic and complains of chest pain radiating to the middle of his back. Physical assessment reveals tachycardia and absent breath sounds in the left lung. The nurse should further assess the client for: ■ 1. An air embolus. ■ 2. A pneumothorax. ■ 3. A pulmonary embolus. ■ 4. A myocardial infarction.

2. The client is exhibiting signs and symptoms of a pneumothorax from the insertion of the subclavian venous catheter. Although it is possible that the client suffered an air embolus during the procedure, and the client is at risk for pulmonary emboli because of his immobility, absent breath sounds immediately after insertion of a subclavian line are strongly suggestive of a pneumothorax. Unilateral absent breath sounds are not associated with a myocardial infarction.

A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her parents live 750 miles away and have only been able to visit twice since her initial diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose chemotherapy. She is concerned about her children's welfare during the treatment. When assessing the client's present support systems, the nurse will be most concerned about the potential problems with: ■ 1. Denial as a primary coping mechanism. ■ 2. Support systems and coping strategies. ■ 3. Decision-making abilities. ■ 4. Transportation and money for the boys.

2. The client's resources for coping with the emotional and practical needs of herself and her family need to be assessed because usual coping strategies and support systems are often inadequate in especially stressful situations. The nurse may be concerned with the client's use of denial, decisionmaking abilities, and ability to pay for transportation; however, the client's support systems will be of more importance in this situation.

The son of a 78-year-old client with metastatic prostate cancer is asking the nurse about the purpose of hospice care. Which of the following statements by the nurse best describes hospice care? ■ 1. "Hospice care uses a team approach to direct hospice activity." ■ 2. "Clients and their families are the focus of care." ■ 3. "The client's physician coordinates all the care." ■ 4. "All hospice clients will die at home."

2. The most important central component of hospice care is focus of care on the client as well as the family or signifi cant other. The team approach and the physician's coordination of the hospice team are important, but they are not the focus. Not all hospice clients want to die at home

When teaching about prevention of infection to a client with a long-term venous catheter, the nurse can document that the client has understood discharge instructions when the client states which of the following? ■ 1. "I will not remove the dressing until I return to the clinic next week." ■ 2. "My husband or I will do the dressing changes three times per week, exactly the way you showed us." ■ 3. "I will monitor my temperature once each weekday." ■ 4. "I know it is very important to wash my hands after irrigating the catheter."

2. The most important intervention for infection control is to continue meticulous catheter site care. Dressings are to be changed two to three times per week depending on institutional policies. Temperature should be monitored at least once a day in someone with a vascular access device. Hand washing before and after irrigation or any manipulation of the site is a must for infection prevention.

A female receiving radiation therapy for lung cancer complains to the nurse that she is having diffi culty sleeping. The nurse should: ■ 1. Suggest the client stop watching television before bed. ■ 2. Assess the client's usual sleep patterns, amount of sleep, and bedtime rituals. ■ 3. Tell the client sleeplessness is expected with radiation therapy. ■ 4. Suggest that the client stop drinking coffee until the therapy is completed.

2. The nurse should fi rst assess the client's usual sleep patterns, hours of sleep required before treatment, and usual bedtime routine. Refraining from watching television before bedtime and avoiding caffeine intake are reasonable suggestions and sleeplessness is an adverse effect of radiation therapy. However, assessment is required before any of these options should be suggested.

The nurse teaches the client with chronic cancer pain about optimal pain control. Which of the following recommendations is most effective for pain control? ■ 1. Get used to some pain and use a little less medication than needed to keep from being addicted. ■ 2. Take prescribed analgesics on an aroundthe-clock schedule to prevent recurrent pain. ■ 3. Take analgesics only when pain returns. ■ 4. Take enough analgesics around the clock so that you can sleep 12 to 16 hours a day to block the pain.

2. The regular administration of analgesics provides a consistent serum level of medication, which can help prevent breakthrough pain. Therefore, taking the prescribed analgesics on a regular schedule is the best way to manage chronic cancerrelated pain. There is little risk for the client with cancer-related pain to become addicted. Sleeping 12 to 16 hours a day would not allow the client to participate in usual daily activities or preferred activities.

. Cancer prevalence is defi ned as: ■ 1. The likelihood cancer will occur in a lifetime. ■ 2. The number of persons with cancer at a given point in time. ■ 3. The number of new cancers in a year. ■ 4. All cancer cases more than 5 years old.

2. The word prevalence in a statistical setting is defi ned as the number of cases of a disease present in a specifi ed population at a given time.

A 48-year-old client with cancer has been receiving 10 mg of I.V. morphine while hospitalized. In order to give an equivalent dose of oral morphine, the nurse should be sure the physician has ordered which of the following doses? ■ 1. 25 mg. ■ 2. 30 mg. ■ 3. 40 mg. ■ 4. 10 mg

2. There is a 1:3 ratio with equianalgesic dosing of I.V. to oral morphine; therefore, the physician should order three times the I.V. dose.

A 60-year-old female with chronic cancer pain has been receiving opiates for 4 months. She rated her pain as an 8 on a 10-point scale before starting the opioid medication. She has just had a thorough examination with no new evidence of increased disease, yet her pain is close to 8 again. The most likely explanation for her increasing pain is: ■ 1. Development of an addiction to the opioids. ■ 2. Tolerance to the opioid. ■ 3. Withdrawal from the opioid. ■ 4. Placebo effect has decreased.

2. Tolerance to an opioid occurs when a larger dose of the analgesic is needed to provide the same level of pain control. The risk of addiction is low with opioids to treat cancer pain. There are no data to support that this client is experiencing withdrawal. Although the client may have experienced a placebo effect at one time, placebo effects tend to diminish over time, especially in regard to chronic cancer pain.

A client with malignant pleural effusions is complaining of dyspnea and chest pain. Place the following interventions that the nurse should perform in the correct order of priority. 1. Administer morphine sulfate 2 mg I.V 2. Apply oxygen at 2 L via nasal cannula. 3. Educate the client in anticipation of a thoracentesis. 4. Coach the client on deep breathing exercise.

2143

Lifestyle infl uences that are considered risk factors for colorectal cancer include: ■ 1. A diet low in vitamin C. ■ 2. A high dietary intake of artifi cial sweeteners (Aspartame). ■ 3. A high-fat, low-fi ber diet. ■ 4. Multiple sex partners.

3. A high-fat, low-fi ber diet is a risk factor for colorectal cancer. A diet low in vitamin C, use of artifi cial sweeteners, and multiple sex partners are not considered risk factors for colorectal cancer.

While talking to her husband, who is caring for their children, a 52-year-old client slams the phone down. She begins to cry and states that she is feeling guilty for being hospitalized. Which of the following interventions will best support the client emotionally? ■ 1. Call the physician and ask for a psychiatry consultation. ■ 2. Call the physician and request an antidepressant medication. ■ 3. Sit with the client and help her acknowledge and discuss her feelings. ■ 4. Sit with the client and encourage her to see the good side of the situation.

3. Acknowledgment and discussion of the client's feelings begin the establishment of a therapeutic relationship between nurse and client. It also acknowledges the seriousness of the current situation and validates the client's feelings. Psychiatric help and antidepressant medication may be options if the depression is severe and prolonged. Encouraging a client to see the good or positive side of a situation minimizes the client's feelings.

A client is transferred to his room from the intensive care unit after a craniotomy for treatment of a malignant brain tumor in the occipital region. The nurse should question which of these orders? ■ 1. 400 mg of ibuprofen (Motrin). ■ 2. 500 mg of naproxen (Naprosyn). ■ 3. Morphine sulfate. ■ 4. Acetaminophen (Tylenol).

3. Administration of morphine sulfate is contraindicated because morphine causes respiratory depression. It may also increase intracranial pressure if the client is not ventilating properly, which could result in an accumulation of CO2 , a potent vasodilator. Ibuprofen, naproxen, and acetaminophen are not likely to mask symptoms of increased intracranial pressure or impact respiratory status.

Which of the following client situations would require the most intensive nursing interventions for immobility? ■ 1. A 38-year-old woman receiving internal radiation therapy for cervical cancer. ■ 2. A 7-year-old boy with leukemia hospitalized for induction of high-dose chemotherapy. ■ 3. A 75-year-old man with metastatic prostate cancer hospitalized for a pathologic fracture of the femur. ■ 4. A 6-month-old undergoing surgery for placement of a central venous catheter.

3. Although each client listed is at some risk of complication secondary to immobility, the 75-year-old man is in need of intensive interventions. Contributing factors include his age, pain management, extended bed rest, and the potential for preexisting nutritional defi cits.

The nurse administers a bolus tube feeding to a client with cancer. Which of the following nursing interventions is most appropriate to decrease the risk of aspiration? ■ 1. Place the client on bed rest with the head of the bed elevated to 60 degrees for 2 hours. ■ 2. Place the client on the left side with the head of the bed at 45 degrees for 15 minutes. ■ 3. Assist the client out of bed to sit upright in a chair for 1 hour. ■ 4. Ask the client to rest in bed with the head of the bed elevated to 30 degrees for 20 minutes.

3. As long as the client is able to get out of bed, the preferred position and time frame for preventing aspiration after a bolus tube feeding is sitting upright out of bed in a chair for 30 to 60 minutes. Placing the client on the right, not the left, side may facilitate gastric emptying, but this is not the preferred position. Elevating the bed 30 degrees decreases the risk of aspiration, but this elevation must be maintained for at least 45 to 60 minutes.

A client with a family history of cancer asks the nurse what the single most important risk factor is for cancer. Which of the following risk factors should the nurse discuss? ■ 1. Family history. ■ 2. Lifestyle choices. ■ 3. Age. ■ 4. Menopause or hormonal events.

3. Because more than 50% of the cancers occur in people who are older than age 65, the single most important factor in determining risk would be age.

A client at risk for lung cancer asks why he is scheduled for a computed tomography (CT) scan as part of his initial workup. The nurse's best response is which of the following? ■ 1. "CT is far superior to magnetic resonance imaging for evaluating lymph node metastasis." ■ 2. "CT is noninvasive and readily available." ■ 3. "CT is useful for distinguishing small differences in tissue density and detecting nodal involvement." ■ 4. "CT can distinguish a malignant from a nonmalignant adenopathy."

3. CT scanning is the standard noninvasive method used in a workup for lung cancer because it can distinguish small differences in tissue density and can detect nodal involvement. CT is comparable to magnetic resonance imaging in evaluating lymph node metastasis. CT is noninvasive and usually available, but these are not the main reasons for its use. CT can distinguish malignancy in some situations only.

The nurse is caring for a 78-year-old male with lung cancer who is receiving chemotherapy. The client states he is not eating well but otherwise feels healthy. Which meal suggestion would be best for this client? ■ 1. Cereal with milk and strawberries. ■ 2. Toast, gelatin dessert, and cookies. ■ 3. Broiled chicken, green beans, and cottage cheese. ■ 4. Steak and french fries.

3. Carbohydrates are the fi rst substance used by the body for energy. Proteins are needed to maintain muscle mass, repair tissue, and maintain osmotic pressure in the vascular system. Fats, in a small amount, are needed for energy production. Chicken, green beans, and cottage cheese are the best selection to provide a nutritionally wellbalanced diet of carbohydrate, protein, and a small amount of fat. Cereal with milk and strawberries as well as toast, gelatin dessert, and cookies have a large amount of carbohydrates and not enough protein. Steak and french fries provide some carbohydrates and a good deal of protein; however, they also provide a large amount of fat.

A 58-year-old male has just had a sclerosing agent instilled after chest tube drainage of a pleural effusion. The nurse should instruct the client to: ■ 1. Lie still to prevent a pneumothorax. ■ 2. Sit upright with arms on an overhead table to promote lung expansion. ■ 3. Change position frequently to distribute the agent. ■ 4. Lie on the side where the thoracentesis was done to hold pressure on the chest tube site

3. Changing positions frequently aids in distributing the agent to the pleura for sealing. The majority of the pleural fl uid is drained, and the lung should already be reexpanded before instillation of the sclerosing agent. A pressure dressing is applied to the chest tube exit site, and it is not necessary to lie on that side to hold pressure on the area.

Which of the following actions should the nurse plan to do fi rst when caring for a client who is experiencing spiritual distress? ■ 1. Make a referral to a member of the clergy. ■ 2. Explain the major beliefs of different religions. ■ 3. Suggest reading material. ■ 4. Help the client explore his or her own values and beliefs.

4. The nurse must fi rst allow the client to explore his or her own beliefs and values before making referrals, explaining various religious beliefs, or suggesting appropriate reading material.

Which of the following clients is at highest risk for colorectal cancer? ■ 1. The client who smokes. ■ 2. The client who eats a vegetarian diet. ■ 3. The client who has been treated for Crohn's disease for 20 years. ■ 4. The client who has a family history of lung cancer.

3. Clients over age 50 who have a history of infl ammatory bowel disease are at risk for colon cancer. The client who smokes is at high risk for lung cancer. While the exact cause is not always known, other risk factors for colon cancer are a diet high in animal fats, including a large amount of red meat and fatty foods with low fi ber, and the presence of colon cancer in a fi rst-generation relative.

The nurse is assessing a client with anemia. In order to plan nursing care, the nurse should focus the assessment on which of the following? ■ 1. Decreased salivation. ■ 2. Bradycardia. ■ 3. Cold intolerance. ■ 4. Nausea.

3. Cold intolerance may be associated with anemia because of the diminished oxygen supply to the peripheral circulation. Decreased salivation is not necessarily associated with anemia. Tachycardia may be expected in severe anemia. Clients with anemia are usually not nauseated.

A client with breast cancer has abdominal bloating and cramping with no bowel movement for 5 days. She says she usually has a bowel movement every day after her morning coffee. Bowel sounds are present in all four quadrants. She received 80 mg of doxorubicin hydrochloride (Adriamycin) 10 days ago. The nurse should contact the health care provider to request an order for which of the following? ■ 1. A Fleet enema to stimulate peristalsis. ■ 2. A soapsuds enema until clear. ■ 3. An oral cathartic until the client has a bowel movement; then evaluate the need for daily stool softeners. ■ 4. A daily stool softener for constipation and a mild opioid for abdominal discomfort.

3. Constipation lasting 3 days or longer is unusual in this client and warrants immediate action. However, because the client had chemotherapy with doxorubicin (Adriamycin) 10 days ago, she is susceptible to infection and should avoid rectal medications and treatments. Abdominal discomfort secondary to constipation will be relieved after the client has a bowel movement; an opioid would contribute to the constipation.

A 62-year-old male with a history of chronic obstructive pulmonary disease (COPD) and metastatic carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice program. The nurse should conduct a focused client assessment for: ■ 1. Ascites. ■ 2. Pleural friction rub. ■ 3. Dyspnea. ■ 4. Peripheral edema.

3. Dyspnea is a distressing symptom in clients with advanced cancer including metastatic carcinoma of the lung, previous radiation therapy, and coexisting COPD. Ascites does occur in clients with metastatic carcinoma; however, in the client with COPD and lung cancer, dyspnea is a more common fi nding. A pleural friction rub is usually associated with pneumonia, pleurisy, or pulmonary infarct.

Experimental and epidemiologic evidence suggests that a high-fat diet increases the risk of several cancers. Which of the following cancers is linked to a high-fat diet? ■ 1. Ovarian. ■ 2. Lung. ■ 3. Colon. ■ 4. Liver.

3. Evidence suggests that a high-fat diet increases the risk of several cancers, including breast, colon, and prostate cancers. Ovarian, lung, and liver cancers have not been linked to a high-fat diet.

Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more effi cient? ■ 1. Teaching the client diaphragmatic breathing techniques. ■ 2. Administering cough suppressants as ordered. ■ 3. Teaching and encouraging pursed-lip breathing. ■ 4. Placing the client in a low semi-Fowler's position.

3. For clients with obstructive versus restrictive disorders, extending exhalation through pursedlip breathing will make the respiratory effort more effi cient. The usual position of choice for this client is the upright position, leaning slightly forward to allow greater lung expansion. Teaching diaphragmatic breathing techniques will be more helpful to the client with a restrictive disorder. Administering cough suppressants will not help respiratory effort. A low semi-Fowler's position does not encourage lung expansion. Lung expansion is enhanced in the upright position.

A client receiving radiation to the head and neck is experiencing stomatitis. The nurse should recommend: ■ 1. Evaluation by a dentist. ■ 2. Alcohol-based mouth wash rinses. ■ 3. Artifi cial saliva. ■ 4. Vigorous brushing of teeth after each meal

3. Head and neck radiation can cause the complication of stomatitis and decreased salivary fl ow. A saliva substitute will assist with dryness, moistening food, and swallowing. Meticulous mouth care is needed; however, alcohol and vigorous brushing will increase irritation. Evaluation by a dentist to perform necessary dental work is done prior to initiation of therapy.

The client with lymphedema has an increased risk of cellulitis and lymphangitis because of: ■ 1. Fragility of the capillaries. ■ 2. Myelosuppression of the bone marrow. ■ 3. Stagnation of accumulated fl uid. ■ 4. Increased use of the extremity.

3. Infection may occur in a client with lymphedema because of the stagnant accumulated fl uid, which becomes an excellent medium for bacteria growth. Capillary permeability, not fragility, increases fl uid in lymphedema. Myelosuppression is not related to lymphedema, only to a neoplastic disease or sequela to treatment of neoplastic disease. Increased use of the extremity may also cause increased accumulation of fl uid, but it is not a direct cause of cellulitis and lymphangitis.

Which of the following interventions will be most effective in improving transcultural communications with oncology clients and their families? ■ 1. Use touch to show concern and caring for the client. ■ 2. Focus attention on verbal communication skills only. ■ 3. Establish a rapport and listen to their concerns. ■ 4. Maintain eye contact at all times.

3. It is important to establish rapport with the client and family by listening to verbal and nonverbal concern and showing respect for cultural differences. The use of touch or eye contact is culture-specifi c and cannot be generalized as an intervention for all individuals with cancer. Miscommunication between individuals of different cultures is often caused by language differences, rules of communication, age, and gender.

A nurse is checking the laboratory results of a 52-year-old client with colon cancer admitted for further chemotherapy. The client has lost 30 lb (13.6 kg) since initiation of the treatment. Which laboratory result should be reported to the health care provider? ■ 1. Blood glucose level of 95 mg/dL. ■ 2. Total cholesterol level of 182 mg/dL. ■ 3. Hemoglobin level of 12.3 mg/dL. ■ 4. Albumin level of 2.8 g/dL.

4. The nurse must recognize that an albumin level of 2.8 g/dL indicates catabolism and potential for malnutrition. Normal albumin is 3.5 to 5.0 g/dL; less than 3.5 indicates malnutrition. The other laboratory results are normal.

A nurse is teaching a 62-year-old female who has had a left modifi ed radical mastectomy with axillary node dissection about lymphedema. The nurse should tell the client that lymphedema occurs: ■ 1. If all cancer cells are not removed. ■ 2. In older women. ■ 3. At any time after surgery or not at all. ■ 4. Only with radical mastectomy.

3. Lymphedema after breast cancer surgery is the accumulation of lymph tissue in the tissues of the upper extremity extending down from the upper arm. It may occur at any time after surgery in women of any age. It is caused by the interruption or removal of lymph channels and nodes after axillary node dissection. Removal results in less effi cient fi ltration of lymph fl uid and a pooling of lymph fl uid in the tissues on the affected side. Treatments or interventions should be instituted as soon as lymphedema is noted to prevent or reduce further progression. Range-of-motion exercises, elevation, and avoidance of injury in the affected arm are important when completing client teaching. Lymphoma is not caused by failure to remove all cancer cells. Lymphedema can occur after any surgery that disrupts lymph fl ow, not just radical mastectomy.

A client's husband expresses concern that his dying wife keeps saying, "I have to go to the store." Which of the following statements by the nurse will be most effective in assisting the husband to understand the dying process? ■ 1. "Many dying clients are restless and can be treated with sedatives." ■ 2. "The client may be fi ghting death and you should leave her alone." ■ 3. "Comments related to going somewhere or leaving on a trip are common in dying clients." ■ 4. "Decreased circulation and lack of oxygen to the brain often causes delirium."

3. Mental changes and decreased level of consciousness are common in the dying process. Comments that allude to travel, trips, or going somewhere are also common. Suggesting that the client be sedated ignores the husband's question about what his wife is experiencing. Suggesting that the client is fi ghting death and that the husband should leave her alone is inappropriate and denies the husband time to spend with his wife. Although decreased circulation and lack of oxygen may cause delirium, delirium is not the norm in the dying process.

A 49-year-old male with a tracheostomy tube confi des to the nurse during a clinic visit that he is beginning to avoid sexual activity because of the increased tracheostomy secretions. Which of the following statements by the nurse will be most helpful to the client? ■ 1. "Use a scopolamine patch to decrease secretions." ■ 2. "Avoid fl uid intake 2 hours before sexual activity." ■ 3. "Place a thin piece of gauze over the tracheostomy." ■ 4. "Wash the tracheostomy area with deodorizing antibacterial soap before sexual activity."

3. Placing a thin piece of gauze over the tracheostomy during sexual activity will help to contain the secretions and yet allow ventilation. Although a scopolamine patch may depress the salivary and bronchial secretions, it is not recommended for long-term use and would not be indicated in this situation. Avoiding fl uids before sexual activity is not recommended to decrease secretions. Washing the tracheostomy area with any deodorizing soap may cause skin irritation and place the client at risk for infection.

An appropriate nursing intervention for a client with fatigue related to cancer treatment includes teaching the client to: ■ 1. Increase fl uid intake. ■ 2. Minimize naps or periods of rest during day. ■ 3. Conserve energy by prioritizing activities. ■ 4. Limit dietary intake of high-fi ber foods.

3. Prioritizing physical activities helps to conserve energy, which promotes adaptation to fatigue. The client should learn to take short naps or short rest periods during the day for additional energy conversation. Increased fl uid intake is important but may interrupt rest periods by causing frequent urination. Limiting intake of high-fi ber foods can add to constipation, which may be a problem because of inactivity in fatigued clients.

The nurse caring for a client who is receiving external beam radiation therapy for treatment of lung cancer should assess the client for which of the following? ■ 1. Diarrhea. ■ 2. Improved energy level. ■ 3. Dysphagia. ■ 4. Normal white blood cell count.

3. Radiation-induced esophagitis with dysphagia is particularly common in clients who receive radiation to the chest. The anatomic location of the esophagus is posterior to the mediastinum and is within the fi eld of primary treatment. Diarrhea may occur with radiation to the abdomen. Decreased energy level and decreased white blood cell count are potential complications of radiation therapy

A 38-year-old female client with a history of breast-conserving surgery, axillary node dissection, and radiation therapy reports that her arm is red, warm to touch, and slightly swollen. Which of the following actions should the nurse suggest? ■ 1. Apply warm compresses to the affected arm. ■ 2. Elevate the arm on two pillows. ■ 3. See the physician immediately. ■ 4. Schedule an appointment within 2 to 3 weeks.

3. Redness, warmth, and swelling are all signs of infection. Treatment with antibiotics is usually indicated. Infection usually increases fl uid accumulation and could worsen the lymphedema. Warm compresses could also increase fl uid accumulation. Elevation will not treat the infection. It is critical that the client not delay treatment.

A 62-year-old male is dying from metastatic lung cancer, and all treatments have been discontinued. The client's breathing pattern is labored, with gurgling sounds. The client's wife asks the nurse, "Can't you do something to help with his breathing?" Which of the following is the nurse's best response in this situation? ■ 1. Direct the unlicensed personnel to assess the client's vital signs and provide oral care. ■ 2. Suction the client so that the client's wife knows all interventions were performed. ■ 3. Reposition the client, elevate the head of the bed, and provide a cool compress. ■ 4. Explain to the wife that it is standard practice not to suction clients when treatments have been discontinued.

3. Repositioning the client, elevating the head of the bed, and providing a cool compress are comfort interventions consistent with the concept of palliative care of the dying. Directing the unlicensed personnel to assess vital signs focuses on the dying process, not the client. Suctioning may not benefi t the client and is considered invasive and uncomfortable. Telling the wife an intervention is not needed discounts her judgment and concerns.

A water test recently revealed arsenic levels above 200 ìg/L. Which of the following cancers would be most likely to develop in those who consistently drank the water? a. Liver b. Skin c. Colon d. Kidney

b. Skin

Doxorubicin (Adriamycin) is prescribed for a female client with breast cancer. The client is distressed about hair loss. The nurse should do which of the following? ■ 1. Have the client wash and massage the scalp daily to stimulate hair growth. ■ 2. Explain that hair loss is temporary and will quickly grow back to its original appearance. ■ 3. Provide resources for a wig selection before hair loss begins. ■ 4. Recommend that the client limit social contacts until hair regrows.

3. Resources should be provided for acquiring a wig since it is easier to match hair style and color before hair loss begins. The client has expressed negative feelings of self image with hair loss. Excessive shampooing and manipulation of hair will increase hair loss. Hair usually grows back in 3 to 4 weeks after the chemotherapy is fi nished, however new hair may have a new color or texture. A wig, hairpiece, hat, scarf, or turban can be used to conceal hair loss. Social isolation should be avoided and the client should be encouraged to socialize with others.

Which of the following groups would benefi t most from education regarding potential risk factors for melanoma? ■ 1. Adults older than age 35. ■ 2. Senior citizens who have been repeatedly exposed to the effects of ultraviolet A and ultraviolet B rays. ■ 3. Parents with children. ■ 4. Employees of a chemical factory.

3. Sun damage is a cumulative process. Parents should be taught to apply sunscreen and teach their children to use sunscreen at an early age. Although preventive education is always valuable, serious sunburns in childhood are associated with an increased risk of melanoma. Adults and senior citizens have already been exposed to the harmful effects of the sun and, although they, too, should use sunscreen, they are not the group that will most benefi t from intervention. Exposure to chemicals is not a risk factor for melanoma.

A 17-year-old, sexually active female client is seen in the family planning clinic and requests hormonal contraceptives. Before examination, the nurse should explain the importance of regular Papanicolaou (Pap) smears. This recommendation is based on the current screening guidelines of the American Cancer Society for Pap smears, which state that: ■ 1. Pap smears are recommended every other year. ■ 2. If four consecutive annual Pap smears are negative, the client should schedule repeat Pap smears every 3 years. ■ 3. The initial Pap smear should be done at age 21 or earlier if the woman is sexually active. ■ 4. If four consecutive smears are negative, the client should request a colposcopy.

3. The American Cancer Society guidelines (2004) state that a Pap smear and pelvic examination should be done 3 years after a woman fi rst has vaginal intercourse, but no later than 21 years of age. Annual Pap smears are recommended only for clients at risk and not for the general female population. After three or more consecutive annual examinations with normal fi ndings, the Pap smear may be performed less frequently at the discretion of the physician. Colposcopy is indicated for an abnormal Pap smear, not a negative Pap smear.

When a 62-year-old client and his family receive the initial diagnosis of colon cancer, the nurse can act as an advocate by: ■ 1. Helping them maintain a sense of optimism and hopefulness. ■ 2. Determining their understanding of the results of the diagnostic testing. ■ 3. Listening carefully to their perceptions of what their needs are. ■ 4. Providing them with written materials about the cancer site and its treatment.

3. The best nursing advocacy intervention is listening carefully to the client's and family's perceptions of their needs. Studies have demonstrated that these needs are not necessarily what the nurse thinks they are. Intervening without listening carefully may result in a lack of responsiveness to the real needs. Helping the client and family maintain a sense of optimism and hopefulness is appropriate but is not necessarily advocacy. Determining the client's and family's understanding of the results of the diagnostic testing and providing written materials about the cancer site and its treatment are examples of the nurse's role as educator.

A client undergoing chemotherapy has a white blood cell count of 2300/mm3 ; hemoglobin of 9.8 g/dL; platelet count of 80,000/mm3 and potassium of 3.8. Which of the following should take priority? ■ 1. Blood pressure 136/88. ■ 2. Emesis of 90 mL. ■ 3. Temperature 101° F (38.3° C). ■ 4. Urine output 40 mL/hour.

3. The client has a low white blood cell count from the chemotherapy and has a temperature. Signs and symptoms of infection may be diminished in a client receiving chemotherapy; therefore, the temperature elevation is signifi cant. Early detection of the source of infection facilitates early intervention.

A 52-year-old client with lung cancer tells the nurse that he has a low-grade fever (100.6° F [38.1° C]), nonproductive cough, and increasing fatigue. He completed the radiation therapy to the mass in his right lung and mediastinum 10 weeks ago and has a follow-up appointment to see the physician in 2 weeks. What is the most appropriate response by the telephone triage nurse? ■ 1. Advise the client to take two acetaminophen tablets every 4 to 6 hours for 2 days and call back if his temperature increases to 101° F (38.3° C) or greater. ■ 2. Advise the client that this is an expected side effect of the radiation therapy and to keep his appointment in 2 weeks. ■ 3. Advise the client to come to the offi ce to be examined today. ■ 4. Advise the client to go to the nearest emergency department.

3. The client is exhibiting early symptoms of pulmonary toxicity as a result of the radiation therapy. These are not expected adverse effects of radiation. He needs to be examined to differentiate between an infection and radiation pneumonitis. Suggesting that the client take acetaminophen and call back in 2 days is inappropriate. These signs and symptoms are not indicative of a true emergency, but the client should be seen before his next scheduled offi ce visit.

A nurse is caring for a client at home on hospice care for terminal renal cancer. People are calling the nurse to inquire about the client's condition. The nurse should tell the callers: ■ 1. "Please call the oncologist." ■ 2. "The client is in a coma now." ■ 3. "Please call the client's sister" ■ 4. "The client is not expected to live much longer."

3. The family is in the best position to give the information they elect to disclose to friends and community members. The hospice nurse and the oncologist must maintain client confi dentiality and follow HIPPA guidlelines for release of confi dential information. Therefore, disclosing any information about the client's condition would be inappropriate.

A 56-year-old client who recently had a right pneumonectomy for lung cancer is admitted to the oncology unit with dyspnea and fever. The nurse should: ■ 1. Place the client on the left side. ■ 2. Position the client for postural drainage. ■ 3. Provide education on deep breathing exercises. ■ 4. Instruct the client to maintain bed rest with bathroom privileges.

3. The fever and dyspnea suggest a respiratory infection. Education on deep breathing exercises or incentive spirometry, elevating the head of the bed, and getting out of bed to a chair is necessary to promote lung expansion. When in bed, positioning the client with good lung down should be avoided, since this impedes expansion of the only lung. Postural drainage positioning will lower the head of bed and increase dyspnea.

A client and nurse have established a goal for the client to be more autonomous. Which of the following situations indicates that the goal has been met? ■ 1. The physician directs the client's care. ■ 2. The nurse provides the client with the facts and then allows the client to reach an unassisted decision. ■ 3. The nurse respects a client's choice not to know particular information. ■ 4. The health care team makes health and treatment decisions.

3. The goal of client autonomy is to respect the client's choice not to know particular information. The client's best interests should be determined by the client after he or she receives all the necessary information and in conjunction with other people of the client's choice, including family, physicians, and other health care personnel. The client's best interests are not totally directed by the physician or the health care team.

The nurse is preparing an educational program on breast cancer for women at an African American community center. What information is important for the nurse to consider for the discussion? ■ 1. African American women have the lowest rate of breast cancer. ■ 2. Most African American women are diagnosed early in the disease process. ■ 3. Breast cancer concerns vary between socioeconomic levels of African American women. ■ 4. African American women believe breast cancer is inevitable.

3. The nurse needs to consider the beliefs and concerns for all socioeconomic levels of African American women when providing education on breast cancer. Access to screening and care may differ. African American women are more likely to develop breast cancer and be diagnosed later in the disease process than Caucasian women. Not all African American women believe that breast cancer is inevitable.

The nurse is working with a client who has cancer to improve the client's independence in activities of daily living after radiation therapy. Which of the following is an appropriate nursing intervention? ■ 1. Refer the client to a community support group after discharge from the rehabilitation unit. ■ 2. Make certain that a family member is present for the rehabilitation sessions. ■ 3. Provide positive reinforcement for skills achieved. ■ 4. Inform the client of rehabilitation plans made by the rehabilitation team.

3. The positive reinforcement builds confi - dence and facilitates achievement of rehabilitation goals. Community support may or may not be applicable after discharge. Although family support is an important component of rehabilitation, reinforcing the skills the client has acquired is of greater importance when regaining independence. Rehabilitation plans should include the client, family, or both.

A registered nurse is assigning care on the oncology unit and assigns the client with Kaposi's sarcoma and human immunodefi ciency virus (HIV) infection to the licensed vocational nurse (LVNLPN). The LVN-LPN states that she does not want to care for this client. How should the nurse respond? ■ 1. "I will assign this client to another nurse." ■ 2. "I will help you take care of this client so you are confi dent with his care." ■ 3. "You seem worried about this assignment." ■ 4. "I will review blood and body fl uid precautions with you."

3. The registered nurse assigning care should fi rst give the LVN-LPN the opportunity to explore his concerns and fears about caring for a client with HIV infection. Reassigning care for this client, assisting with care, and reviewing precautions do not address the present concern or create an environment that will generate useful knowledge regarding future assignments for client care.

A client receiving chemotherapy for metastatic colon cancer is admitted to the oncology unit due to several days of vomiting. Assessment fi ndings include: irregular pulse of 120, blood pressure 88/48, respiratory rate of 14, serum potassium of 2.9 mEq/L, and arterial blood gas—pH 7.46, PCO2 45, PO2 95, bicarbonate level 29 mEq/L. Which of the following interventions is appropriate for the nurse to administer to the client? ■ 1. Oxygen at 4L per nasal cannula. ■ 2. Potassium 40 mEq PO now. ■ 3. 5% Dextrose in 0.45% Normal Saline with KCl 40 mEq/L at 125 mL/hour. ■ 4. NaHCO3 75 mEq IV.

3. The vital signs suggest that the client is dehydrated from the vomiting. I.V. fl uids should be initiated with the addition of potassium. Oral potassium should be avoided since the client is vomiting and potassium is irritating to the stomach. Oxygen is not indicated at this time since the PO2 is 95. The client with a metabolic alkalosis should not receive sodium bicarbonate; this will increase the alkalosis.

A client with pancreatic cancer is receiving morphine via a subcutaneous pump. The client is developing drug tolerance. The nurse understands that the client is: ■ 1. Tolerating the medication well. ■ 2. Showing addiction to morphine. ■ 3. Requiring an increased dose. ■ 4. Experiencing physical dependence.

3. Tolerance develops from taking opioids over an extended period. It is characterized by the need for an increased dose to achieve the same degree of analgesia. Addiction is characterized by a drive to take the medication for the psychic effect rather than the therapeutic effect. Physical dependence is a response to ongoing exposure to a medication manifested by withdrawal symptoms when discontinued abruptly

A 36-year-old female is complaining of increased vaginal dryness during sexual intercourse. She has received chemotherapy in the past and has menopausal symptoms due to ovarian suppression. An appropriate nursing intervention would be to instruct the client on the use of: ■ 1. Vaginal dilators. ■ 2. Nightly douches. ■ 3. Water-soluble vaginal lubricants. ■ 4. Relaxation techniques.

3. Water-soluble lubricants used during sexual intercourse can augment reduced natural vaginal lubrication caused by ovarian dysfunction and decreased circulating estrogen related to chemotherapy. The use of vaginal dilators, relaxation techniques, or nightly douches would not increase vaginal lubrication. Frequent douching can disrupt the normal vaginal environment.

A client has malignant pleural effusions. The nurse should conduct a focused assessment to determine if the client has which of the following? Select all that apply. ■ 1. Hiccups. ■ 2. Weight gain. ■ 3. Peripheral edema, ■ 4. Chest pain. ■ 5. Dyspnea. ■ 6. Cough.

4, 5. A malignant pleural effusion is an accumulation of excessive fl uid within the pleural space that occurs when cancer cells irritate the pleural membrane. Dyspnea can result from the increased pressure that may contribute to increased anxiety and fear of suffocation. Pain is a consequence of the pleural irritation. Cough is related to the atelectasis of the bronchi and inability to clear the airways. Hiccups are usually associated with pericardial effusions. Weight gain and peripheral edema may occur with peritoneal effusion.

An 82-year-old elderly, alert, and oriented female with metastatic lung cancer is admitted to the medical-surgical unit for treatment of heart failure. She was given 80 mg of furosemide (Lasix) in the emergency department. Although the client is ambulatory, the unlicensed assistive personnel are concerned about urinary incontinence because the client is frail and in a strange environment. The nurse should instruct the unlicensed personnel to assist with implementing the nursing plan of care by: ■ 1. Ordering adult diapers for the client so she will not have to worry about incontinence. ■ 2. Requesting an indwelling urinary catheter to avoid incontinence. ■ 3. Padding the bed with extra absorbent linens. ■ 4. Placing a commode at the bedside and instructing the client in its use.

4. A bedside commode should be near the client for easy, safe access. Measurement of urine output is also important in a client with heart failure. Putting diapers on an alert and oriented individual would be demeaning and inappropriate. Indwelling catheters are associated with increased risk of infection and are not a solution to possible incontinence. There is no reason to think that the client would not be able to use the bedside commode.

A client is receiving vincristine (Oncovin). Client teaching by the nurse should include instructions on: ■ 1. Use of loperamide (Imodium). ■ 2. Fluid restriction. ■ 3. Low fi ber, bland diet. ■ 4. Bowel regimen.

4. A side effect of vincristine is constipation and a bowel protocol should be considered. Imodium is used to treat diarrhea. Fluids should be encouraged, along with high fi ber foods to prevent constipation.

A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate? ■ 1. Apply sunscreen only after going into the water. ■ 2. Avoid peak exposure hours from 9 a.m. to 1 p.m. ■ 3. Wear loosely woven clothing for added ventilation. ■ 4. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

4. A sunscreen with an SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It should be applied before sun exposure and reapplied after being in the water. Peak sun exposure usually occurs from 10 a.m. to 2 p.m. Tightly woven clothing, protective hats, and sunglasses are recommended to decrease sun exposure. Suntanning parlors should be avoided.

The nurse is assessing a 60-year-old male who has hoarseness. The nurse should conduct a focused assessment to determine: ■ 1. Patterns of medication use and history of alcohol consumption. ■ 2. Exposure to sun and family history of head and neck cancers. ■ 3. Exposure to wood dust and a high-fat diet. ■ 4. History of tobacco use and alcohol consumption.

4. Although exposure to the sun increases the risk of skin cancers and family history is signifi - cant in the development of some types of cancer, heavy tobacco use and alcohol intake have a synergistic effect and increase the risk and incidence of head and neck cancers. Patterns of medication use, exposure to wood dust, and a high-fat diet are not associated with an increased risk and incidence of head and neck cancers.

A young man with early-stage testicular cancer is scheduled for a unilateral orchiectomy. The client confi des to the nurse that he is concerned about what effects the surgery will have on his sexual performance. Which of the following responses by the nurse provides accurate information about sexual performance after an orchiectomy? ■ 1. "Most impotence resolves in a couple of months." ■ 2. "You could have early ejaculation with this type of surgery." ■ 3. "We will refer you to a sex therapist because you will probably notice erectile dysfunction." ■ 4. "Because your surgery does not involve other organs or tissues, you'll likely not notice much change in your sexual performance."

4. Although there may not be a big change in sexual function with a unilateral orchiectomy, the loss of a gonad and testosterone may result in decreased libido and sterility. Sperm banking may be an option worth exploring if the number and motility of the sperm are adequate. Remember, the population most affected by testicular cancer is generally young men ages 15 to 34, and in this crucial stage of life, sexual anxieties may be a large concern.

In setting goals for a client with advanced liver cancer who has poor nutrition, the nurse determines that which of the following is a realistic desired outcome for the client? The client will: ■ 1. Have normalized albumin levels. ■ 2. Return to ideal body weight. ■ 3. Gain 1 lb every 2 weeks. ■ 4. Maintain current weight.

4. An appropriate and realistic outcome would be for the client to maintain current weight or not lose weight. It is unrealistic to expect that the client with advanced liver cancer will have normal albumin levels or will be able to gain weight.

A nurse is conducting a cancer risk screening program. Which of the following clients is at greatest risk for skin cancer? ■ 1. 45-year-old physician. ■ 2. 15-year-old high school student. ■ 3. 30-year-old butcher. ■ 4. 60-year-old mountain biker.

4. Basal cell carcinoma occurs most commonly in sun-exposed areas of the body. The incidence of skin cancer is highest in older people who live in the mountains or spend outdoor leisure time at higher altitudes.

The most appropriate suggestion for the hospice nurse to give a woman whose husband died 3 months ago and her three young children would be to: ■ 1. Seek group counseling support for the three children. ■ 2. Request individual counseling and medication to manage depression. ■ 3. Remind her gently that bereavement care before death minimizes grieving. ■ 4. Continue her bereavement support through hospice.

4. Bereavement support after death usually continues for about 1 year or as needed at little or no cost to the remaining family. Mutual support groups by nonprofessionals are usually free or inexpensive but are not necessarily appropriate for young children. Professional individual counseling and medication are expensive, and medication may not be appropriate for young children. To remind someone of what she should have done before the death is not helpful at this time.

A client admitted to the hospital for the third time is diagnosed as having acute lymphatic leukemia. The liaison psychiatric nurse is asked by the team leader to help the nursing staff work more effectively with this terminally ill child and his family. One of the nurses says to the liaison nurse, "Whenever I go to the client's room, I feel that I have to smile and act happy even though I want to cry when I see him." Which of the following responses by the liaison nurse would be most appropriate? ■ 1. "Call me when you feel that way. We can talk it over at the time." ■ 2. "Try not to show emotion, such as crying. You'll upset the client." ■ 3. "Keep smiling. The client and family need all the support they can get." ■ 4. "Tell the client you feel bad because he is ill and cry, too, if it seems appropriate."

4. Clients often sense a nurse's feelings. Therefore, when the nurse becomes emotionally upset it is appropriate to share her emotions with the client; it is also acceptable to cry. It is of little help to the client or the nurse who is upset if the nurse waits until a later time to speak to someone about the situation. Trying to smile or not to show emotion is inappropriate; clients are very aware of someone's incongruent mood and behavior.

A 56-year-old client is receiving chemotherapy that has the potential to cause pulmonary toxicity. Which of the following symptoms indicates a toxic response to the chemotherapy? ■ 1. Decrease in appetite. ■ 2. Drowsiness. ■ 3. Spasms of the diaphragm. ■ 4. Cough and shortness of breath.

4. Cough and shortness of breath are signifi - cant symptoms because they may indicate decreasing pulmonary function secondary to drug toxicity. Decrease in appetite, diffi culty in thinking clearly, and spasms of the diaphragm may occur as a result of chemotherapy; however, they are not indicative of pulmonary toxicity.

The family members caring for a 72-year-old client who is near death from colon cancer are concerned about dehydration. What should the nurse tell them about dehydration at end of life? ■ 1. The physician will make the decision regarding hydration therapy. ■ 2. Dehydration may prolong the dying process. ■ 3. Hydration is used only in extreme situations of dehydration. ■ 4. Dehydration is expected during the dying process.

4. Dehydration is an expected event within the dying process. Hydration may be used in any situation of dehydration as long as it is within the client and family's wishes. Rehydrating the client may actually prolong the dying process. Decisions about treatment are made with the family.

A daughter is concerned that her mother is in denial when discussing her diagnosis of breast cancer because she sometimes says that breast cancer isn't that serious and changes the subject. The nurse informs the daughter that denial can be a healthy defense mechanism if it is used: ■ 1. To permit her mother to seek unconventional treatments. ■ 2. When making decisions about her care. ■ 3. Alone and not in combination with other defense mechanisms. ■ 4. To allow her mother to continue in her role as a mother.

4. Denial is a defense mechanism used to shut out a situation that is too frightening or threatening to tolerate. In this case, denial allows the client to vacillate between acceptance of the illness and its treatment and denial of the actual or potential seriousness of the disease. This may allow the client more psychological freedom to maintain her current roles in the family and elsewhere. Denial can be harmful if the client ignores standard medical therapies in favor of unconventional treatments. Denial is not helpful when it interferes with a client's willingness to seek treatment or make decisions about care. Using any one defense mechanism exclusively usually refl ects maladaptive coping. Other defense mechanisms that may be used include regression, humor, and sublimation.

A 42-year-old client with breast cancer is concerned that her husband is depressed by her diagnosis. Which of the following changes in her husband's behavior may confirm her fears? ■ 1. Increased decisiveness. ■ 2. Problem-focused coping style. ■ 3. Increase in social interactions. ■ 4. Disturbance in his sleep patterns.

4. Depression can be a mixture of affective responses (feelings of worthlessness, hopelessness, sadness), behavioral responses (appetite changes, withdrawal, sleep disturbances, lethargy), and cognitive responses (decreased ability to concentrate, indecisiveness, suicidal ideation). Increased decisiveness, problem-solving ability, and increased social interactions are refl ective of adaptive coping.

A 56-year-old female is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She has pain while swallowing and burning and tightness in her chest. The nurse should further assess the client for indications of: ■ 1. Hiatal hernia. ■ 2. Stomatitis. ■ 3. Radiation enteritis. ■ 4. Esophagitis.

4. Diffi culty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall. Hiatal hernia is a herniation of a portion of the stomach into the esophagus. The client could experience burning and tightness in the chest secondary to a hiatal hernia, but not pain when swallowing. Also, hiatal hernia is not a complication of radiation therapy. Stomatitis is an infl ammation of the oral cavity characterized by pain, burning, and ulcerations. The client with stomatitis may experience pain with swallowing, but not burning and tightness in the chest. Radiation enteritis is a disorder of the large and small bowel that occurs during or after radiation therapy to the abdomen, pelvis, or rectum. Nausea, vomiting, abdominal cramping, the frequent urge to have a bowel movement, and watery diarrhea are the signs and symptoms.

The nurse is assessing a 42-year-old client with cancer. He has lost 1 lb in 4 weeks. He is taking ondansetron (Zofran) for nausea. He has a temperature of 101° F (38.3° C). The fever is indicative of: ■ 1. Inadequate nutrition. ■ 2. New resistance to current antiemetic therapy. ■ 3. Expected response to chemotherapy treatment. ■ 4. Infection.

4. Fever is most commonly related to infection. In a neutropenic client, fever frequently occurs in the absence of the usual clinical signs and symptoms of infection. Inadequate nutrition or a ntiemetic therapy resistance would not result in fever. Fever is not usually expected with most chemotherapy drugs.

The nurse is aware that a 65-year-old widower whose only son is 500 miles away is at higher risk for psychosocial distress because the client: ■ 1. Has been successful in dealing with stress all his life. ■ 2. Does not have to deal with other stressors right now. ■ 3. Is able to use denial as a coping mechanism. ■ 4. Perceives he has minimal social support.

4. The person who has minimal social support, has not been successful in dealing with stressors, and has multiple other stressors is at greater risk for psychosocial distress. Being successful in dealing with stress all his life would decrease the client's risk for psychosocial distress. Not having to deal with other stressors would be helpful in managing the current stressful situation. The denial coping mechanism, if used for short periods, can decrease the risk for psychosocial distress.

Which of the following nursing interventions will be most effective when caring for a client who is experiencing powerlessness? ■ 1. Make certain that all staff members focus only on the client's capabilities. ■ 2. Encourage family members to become more responsible for the client's care. ■ 3. Request a referral to a psychologist. ■ 4. Include the client in decision making whenever possible.

4. Focusing on the client's physical capabilities is important, but powerlessness refl ects a perceived lack of control over the current situation and the belief that one's actions will not affect the outcome. Participation in decision making is key to getting the client involved and feeling more in control of his own care. Apathy and dependence on others are characteristics of powerlessness. Encouraging others to take responsibility for the client's care will increase his feelings of powerlessness. A referral to a psychologist is not necessarily indicated. The nurse should implement strategies to involve the client in decisions about his care and evaluate the response to this intervention before suggesting a referral.

Which of the following factors assists a person to achieve positive bereavement outcomes? ■ 1. Young age. ■ 2. History of anxiety. ■ 3. History of depression. ■ 4. Higher socioeconomic status.

4. Having a higher socioeconomic status helps a person achieve healthy bereavement. Younger people are at higher risk for negative bereavement outcomes. Having a history of depressive illness or anxiety is a risk factor for negative bereavement outcomes.

A client is beginning external beam radiation therapy to the right axilla after a lumpectomy for breast cancer. Which of the following should the nurse include in client teaching? ■ 1. Use a heating pad under the right arm. ■ 2. Immobilize the right arm. ■ 3. Place ice on the area after each treatment. ■ 4. Apply deodorant only under the left arm.

4. Hot, cold, and chemical applications to the area treated should be avoided. The client should be encouraged to use the extremity to prevent muscle atrophy and contractures.

A client is newly diagnosed with cancer and is beginning a treatment plan. Which of the following nursing interventions will be most effective in helping the client cope? ■ 1. Assume decision making for the client. ■ 2. Encourage strict compliance with all treatment regimens. ■ 3. Inform the client of all possible adverse treatment effects. ■ 4. Identify available resources.

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

Which of the following variables is most important to assess when determining the impact of the cancer diagnosis and treatment modalities on a long-term survivor's quality of life? ■ 1. Occupation and employability. ■ 2. Functional status. ■ 3. Evidence of disease. ■ 4. Individual values and beliefs.

4. Individuals with cancer have various cultural values and beliefs that help them cope with the cancer experience. Quality of life cannot be evaluated solely by quantifi able factors such as employability, functional status, or evidence of disease. It must be evaluated by the survivors within the context of their subjective and individual values and beliefs

The nurse formulates a nursing diagnosis of Spiritual distress related to advanced cancer disease. An appropriate goal for the client would be to: ■ 1. Start attending church or chapel services once a week. ■ 2. Call a chaplain and set up an appointment for spiritual guidance. ■ 3. Refl ect on past accomplishments. ■ 4. Participate in spiritual activities of the client's choice.

4. It is important to allow the client to choose his or her own form of spiritual support. The dying client who is weakened by disease may not be able to attend services. The client must be consulted before referral to a chaplain is made. Refl ection on past accomplishments may be comforting to the client, but it does not directly address spiritual concerns.

The wife of a terminally ill client asks the nurse, "Why is my husband having frequent bowel movements if he is not eating?" Which of the following responses by the nurse informs the wife about the client's condition? ■ 1. "I know he is having frequent loose stools and it is distressing for you, but that's just the way it is." ■ 2. "I don't know when the bowels will shut down, but they will eventually." ■ 3. "The pain medication will eventually help to slow the process of bowel function." ■ 4. "The intestines still produce some waste products even when a person is not eating."

4. It is important to give factual information to answer a loved one's questions and concerns. Stating, "That's just the way it is," is unprofessional and uncaring. Saying, "I don't know when the bowels will shut down, but they will eventually," projects an uncaring attitude and does not address the wife's concern for her husband or her need for information. Although it may be true that the pain medication will slow bowel function, this does not provide the wife with the information she is seeking.

A 56-year-old cancer survivor feels guilty at the "I Can Cope" meetings. The nurse can help him manage his feelings of guilt by pointing out that: ■ 1. He is really angry at the terminally ill clients in the group. ■ 2. He is experiencing very volatile emotions. ■ 3. This is a spiritual response to his illness. ■ 4. This is a normal reaction when surviving a life-threatening experience.

4. Many cancer survivors question why they are doing so well and others are not. Often they express feeling guilty when they hear that others are not doing well. Suggesting that the client does not know how to describe his own emotions is inappropriate and may discourage him from expressing his feelings. Although the client may be experiencing volatile emotions, this is not the likely source of his feelings of guilt. Guilt about doing well after cancer treatment is not a spiritual response to illness.

A client reciving chemotherapy has experienced a fl are-up of pruritus. In order to develop a care plan, the nurse should ask the client if she has been? ■ 1. Wearing clothes made from 100% cotton. ■ 2. Sleeping in a cool, humidifi ed room. ■ 3. Increasing fl uid intake to at least 3,000 mL/ day. ■ 4. Taking daily baths with a deodorant soap.

4. Use of deodorant or fragrant soaps is drying to the skin. Cotton clothing gives the least irritation to skin. A cool, humidifi ed environment adds to the client's comfort as well as providing hydration for skin comfort. Fluid intake of 3,000 mL day is recommended for adequate hydration.

A 52-year-old male was discharged from the hospital for cancer-related pain. His pain appeared to be well controlled on the I.V. morphine. He was switched to oral morphine when discharged 2 days ago. He now reports his pain as an 8 on a 10-point scale and wants the I.V. morphine. Which of the following represents the most likely explanation for the client's reports of inadequate pain control? ■ 1. He is addicted to the I.V. morphine. ■ 2. He is going through withdrawal from the I.V. opioid. ■ 3. He is physically dependent on the I.V. morphine. ■ 4. He is undermedicated on the oral opioid.

4. Most cancer clients with inadequate pain control while taking an oral opioid after being switched from I.V. administration have been undermedicated. Equianalgesic conversions should be made to provide estimates of the equivalent dose needed for the same level of relief as provided by the I.V. dose. There is research to suggest that cancer clients do not become addicted to opioids when dosed adequately. There is no evidence to suggest that the client is physically addicted or is having withdrawal symptoms.

The most common issue associated with sleep disturbances in the hospitalized client with cancer is: ■ 1. Social. ■ 2. Nutritional. ■ 3. Cultural. ■ 4. Psychological.

4. Most hospitalized persons are at risk for sleep disturbances. Psychological issues (such as anxiety and depression) and pain are related to sleep deprivation. Social, nutritional, and cultural issues are not necessarily associated with sleep disturbances.

Which of the following reasons explains why meperidine (Demerol) is not recommended for chronic cancer-related pain? ■ 1. It has a high potential for abuse. ■ 2. It has agonist-antagonist properties. ■ 3. It must be given intramuscularly to be effective. ■ 4. It contains a metabolite that causes seizures.

4. Normeperidine is a potent long-acting metabolite, which can cause central nervous system (CNS) stimulation and seizures. Meperidine is a short-acting drug and must be given in more frequent intervals and may require increased dosages for effectiveness. Mixed agonist-antagonists act competitively at different pain receptor sites. It is generally accepted by cancer pain experts that opioid agonist-antagonist drugs have very limited usefulness in cancer pain management because of their tendency to induce opioid withdrawal and cause severe CNS adverse effects. Meperidine does not have a higher potential for abuse than other opioids. There are other routes of meperidine administration, so the route of administration is not the limiting factor.

Which of the following represents the most appropriate nursing intervention for a client with pruritus caused by cancer or the treatments? ■ 1. Administration of antihistamines. ■ 2. Steroids. ■ 3. Silk sheets. ■ 4. Medicated cool baths.

4. Nursing interventions to decrease the discomfort of pruritus include those that prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated baths with salicylic acid or colloidal oatmeal can be soothing as a temporary relief. The use of antihistamines or topical steroids depends on the cause of the pruritus, and these agents should be used with caution. Using silk sheets is not a practical intervention for the hospitalized client with pruritus.

A nurse is assessing a 42-year-old client who has been receiving chemotherapy. The client has a platelet count of 22,000 cells/mm3 and has petechiae on the lower extremities. The nurse should advise the client to: ■ 1. Increase the amount of iron in the client's diet. ■ 2. Apply lotion to the lower extremities. ■ 3. Elevate the legs. ■ 4. Consult the oncologist.

4. Petechiae are tiny purplish, hemorrhagic spots visible under the skin. Petechiae usually appear when platelets are depleted. Bleeding gums or oozing of blood may accompany the petechiae, and the client should seek medical assistance immediately. Increasing iron in the diet will not improve the platelet count. Lotion will not treat the petechiae. Elevating the legs will not cause the petechiae to disappear

After surgery for head and neck cancer, a client has a permanent tracheostomy. The nurse should teach the client and family about the importance of : ■ 1. Providing tracheostomy site care. ■ 2. Addressing the psychosocial issues related to tracheostomy. ■ 3. Observing for early signs and symptoms of skin breakdown around the tracheostomy site. ■ 4. Using humidifi ers to prevent thick, tenacious secretions.

4. Providing adequate humidifi cation for the client with a tracheostomy is essential. The client no longer has the functions of the nose for warming, moistening, or fi ltering the air when breathing through the tracheostomy site. Providing tracheostomy site care, addressing the psychosocial issues, and observing for early signs and symptoms of skin breakdown around the tracheostomy site are also important; however, using humidifi ers to prevent thick, tenacious secretions is the most important recommendation for long-term management and the prevention of pulmonary infection.

Which of the following activities indicates that the client with cancer is adapting well to body image changes? ■ 1. The client names his brother as the person to call if he is experiencing suicidal ideation. ■ 2. The client discusses changes in body structure and function. ■ 3. The client discusses the date of his return to work. ■ 4. The client serves as a volunteer in a cl ientto-client visitation program.

4. Serving as a volunteer in a client-to-client program represents reintegration with constructive channeling of energies, which indicates a higher level of adaptation than attention to safety, knowledge, or planned activity.

A 66-year-old female who is usually meticulous about her appearance and dress arrives today for her 23rd day of radiation therapy. She appears disheveled and emotionally labile, and her responses to the usual questions are a little inappropriate. Her heart rate is 124 bpm, her respirations are 32 breaths/minute, and her skin is cold and clammy. These fi ndings would suggest that the nurse should further assess the client for which of the following conditions? ■ 1. Schizophrenia. ■ 2. Panic disorder. ■ 3. Depression. ■ 4. Delirium.

4. Tachycardia, tachypnea, moist or clammy skin, and disorientation are classic symptoms of delirium. Clients with panic disorder do not exhibit disorientation. Clients with depression exhibit a fl at affect, apathy, and sleep disturbances. Clients with schizophrenia have thought disorders such as hallucinations or delusions.

Which of the following characteristics displayed by the wife of a 36-year-old man with pancreatic cancer suggests that she may be at risk for negative bereavement outcomes? ■ 1. She is preparing for her husband's death. ■ 2. Her high socioeconomic status. ■ 3. Her strong family support. ■ 4. She blames herself for her husband's cancer

4. Variables that are most predictive of negative bereavement outcomes include anger and self-reproach, low socioeconomic status, lack of preparation for death, and lack of family support. Making preparations suggests that she is coping with her husband's approaching death.

The nurse can be an important advocate for the client who is considering an alternative method of cancer treatment. Which of the following statements best demonstrates the nurse as client advocate? ■ 1. The nurse will provide the information about standard therapies. ■ 2. The nurse will monitor blood tests as indicated by the alternative therapy. ■ 3. The nurse will document the client's desire to try an alternative therapy. ■ 4. The nurse will allow the client to make health care choices on her own but will assist in ensuring the client is fully informed when making those decisions.

4. The advocacy role of the nurse implies that the nurse will ensure that the client's wishes are being respected and that she is making informed decisions. Therefore, the nurse will assist in ensuring that the client is fully informed. The other interventions are appropriate for the nurse but are not related to client advocacy. The client may not understand or have all the necessary information for standard therapy. A client who is taking an alternative therapy should be monitored for adverse effects. If a client is taking an alternative therapy, it is essential for the physician to know so that the therapy can be incorporated into the client's treatment plan and to ensure that there are no incompatibilities with other therapies or medications.

A 42-year-old female highway construction worker is concerned about her cancer risks. She reveals that she has been married for 18 years, has two children, smokes one pack of cigarettes per day, and drinks one to two beers with her husband after work almost every day. She is 30 lb overweight, eats fast food often, and rarely eats fresh fruits and vegetables. Her mother was diagnosed with breast cancer 2 years ago. Her father and an aunt both died of lung cancer. She had a basal cell carcinoma removed from her cheek 3 years earlier. What combination of behavioral changes should the nurse instruct this client to make fi rst? ■ 1. Decrease fat in the diet, decrease alcohol consumption, and use sunscreen every day. ■ 2. Decrease intake of salt-cured food, lose weight, and stop smoking. ■ 3. Stop drinking beer, decrease fi ber in the diet, and use sun protection. ■ 4. Stop smoking, use sun protection, and lose weight.

4. The client is at increased risk for development of lung, skin, or breast cancer. Consequently, the most urgent changes in behavior should include smoking cessation, protection from the sun, and weight loss. Decreasing alcohol consumption is certainly desirable, as is improving overall nutritional intake (e.g., eating low-fat foods, increasing fi ber) but is not the most urgent behavior change for this client.

A 32-year-old female meets with the nurse on her fi rst offi ce visit since undergoing a left mastectomy. When asked how she is doing, the woman says her appetite is still not good, she is not getting much sleep because she doesn't go to bed until her husband is asleep, and she is really anxious to get back to work. Which of the following nursing interventions should the nurse explore to support the client's current needs? ■ 1. Call the physician to discuss allowing the client to return to work earlier. ■ 2. Suggest that the client learn relaxation techniques for help with her insomnia. ■ 3. Perform a nutritional assessment to assess for anorexia. ■ 4. Ask open-ended questions about sexuality issues related to her mastectomy.

4. The content of the client's comments suggests that she is avoiding intimacy with her husband by waiting until he is asleep before going to bed. Addressing sexuality issues is appropriate for a client who has undergone a mastectomy. Rushing her return to work may debilitate her and add to her exhaustion. Suggesting that she learn relaxation techniques for help with her insomnia is appropriate; however, the nurse must fi rst address the psychosocial and sexual issues that are contributing to her sleeping diffi culties. A nutritional assessment may be useful, but there is no indication that she has anorexia.

A client with advanced ovarian cancer takes 150 mg of long-acting morphine orally every 12 hours for abdominal pain. When the client develops a small bowel obstruction, the physician discontinues the oral morphine and begins morphine 6 mg/ hour I.V. After calculating the equianalgesic conversion from oral to intravenous morphine, the nurse should: ■ 1. Continue the oral morphine for one more dose after the I.V. morphine is started. ■ 2. Contact the physician to suggest a higher equianalgesic dose of I.V. morphine. ■ 3. Administer the morphine I.V. as ordered. ■ 4. Clarify the order to recommend the initial morphine dose of 4 mg/hour.

4. The conversion ratio for morphine is 10 mg I.V. equals 30 mg oral, or 1:3. The client is receiving 300 mg orally per 24 hours, which is equivalent to 100 mg of I.V. morphine. Morphine 100 mg I.V./24 hours = approximately 4 mg/hour I.V. The effect of the I.V. morphine is quick and the oral morphine should be discontinued prior to starting the I.V. morphine. Morphine at 6 mg or higher are above the initial conversion dose from oral to I.V. and can cause untoward side effects.

A client in a hospice program has increasing pain. The nurse and client collaborate to schedule analgesics to provide which of the following? ■ 1. Doses of analgesic when pain is a "5" on a scale of 1-10. ■ 2. Enough analgesia to keep the client semisomnolent. ■ 3. An analgesia-free period so that the client can carry out daily hygienic activities. ■ 4. Around-the-clock routine administration of analgesics for continuous pain relief.

4. The desired outcome for management of pain is that the client's or family's subjective report of pain is acceptable and documented using a pain scale; the goal is that behavioral and physiologic indicators of pain are absent around the clock. The nurse and client/family should develop a systematic approach to pain management using information gathered from history and a hierarchy of pain measurement. Pain should be assessed at frequent intervals. The client should not wait to receive medication until the pain is midpoint on the pain scale, nor should the client receive so much pain medication that he or she is not alert. Continuous pain relief is the goal, not just during particular periods during the day.

During the nursing shift report, the team leader lists tasks and routines completed for a terminally ill client. Which of the following kinds of behavior is the nurse most likely demonstrating when emphasizing the technical aspects of caring for a dying client? ■ 1. Tactful behavior. ■ 2. Effi cient behavior. ■ 3. Objective behavior. ■ 4. Defensive behavior.

4. The nurse caring for a terminally ill client who reports only tasks and routines completed for the client is probably behaving defensively. This behavior does not convey compassion and caring for the client. It is likely that this nurse has not come to grips with death and dying. Tactful behavior respects the client's needs. Effi cient care will prevent unnecessary disturbance for the client. When caring for a terminally ill client, the nurse can remain objective while providing comprehensive nursing care to this client.

A client with cancer has diarrhea and a nursing diagnosis of Impaired skin integrity related to the frequent diarrhea. Which of the following nursing interventions is appropriate for this diagnosis? ■ 1. Discourage sitz baths because they promote bacterial growth. ■ 2. Apply zinc oxide ointment to the rectal area after each bowel movement to protect the skin. ■ 3. Apply a skin-barrier dressing daily to the rectal area to form a protective barrier. ■ 4. Clean the rectal area with unscented soap and water after each bowel movement, rinse well, and pat dry

4. The rectal area needs to be cleaned and gently dried after each bowel movement to prevent skin breakdown and inhibit growth of bacteria. Sitz baths are appropriate because they promote comfort. Zinc oxide ointment does form a protective skin barrier, but it makes it diffi cult to thoroughly clean the perirectal area of feces and increases the risk of infection, as do skin-barrier dressings.

A 68-year-old client with colon cancer experiences an increase in his feelings of anxiety and depression and has suicidal ideation. He appears to be in great distress. The nurse realizes that he is at which stage in his disease? ■ 1. Initiation of defi nitive treatment. ■ 2. End of his fi rst course of treatment. ■ 3. End stage of his disease. ■ 4. Recurrence of the disease.

4. The recurrence of the disease is found to be the most distressing time, and clients may experience anxiety, depression, and suicidal ideation. Clients may feel a decrease in their anxiety and depression with the initiation of defi nitive treatment or at the end of their fi rst course of treatment. Clients in the end stage of the disease may feel all of these emotions; however, when clients have been free from cancer for some time and learn that there is a recurrence, they often experience a sharp increase in their feelings of distress.

A young female client is receiving chemotherapy and mentions to the nurse that she and her husband are using a diaphragm for birth control. Which of the following is most important for the nurse to discuss? ■ 1. Inconvenience of the diaphragm. ■ 2. Transmission of sexually transmitted diseases. ■ 3. Body changes related to hormones. ■ 4. Infection control.

4. The risk of becoming neutropenic during chemotherapy is very high. Therefore, an inserted foreign object such as a diaphragm may be a nidus for infection. Although the nurse may wish to inform the client about the ease with which various contraceptive modalities may be used, the focus of this discussion should be on preventing an infection, which can be fatal for the neutropenic client. There are no data to suggest the client is at risk for acquiring a sexually transmitted disease. The client will not be experiencing body changes directly related to hormonal changes.

A terminally ill 82-year-old client in hospice care is experiencing nausea and vomiting because of a partial bowel obstruction. To respect the client's wishes for conservative management of the nausea and vomiting, the nurse should recommend the use of: ■ 1. A nasogastric (NG) suction tube. ■ 2. I.V. antiemetics. ■ 3. Osmotic laxatives. ■ 4. A clear liquid diet.

4. The use of diet modifi cation is a conservative approach to treat the terminally ill or hospice clients who have nausea and vomiting related to bowel obstruction. Osmotic laxatives would be harder for the client to tolerate. An NG tube is more aggressive and invasive. I.V. antiemetics are also invasive. The hospice philosophy involves comfort and palliative care for the terminally ill.

The "I Can Cope," "CanSurmount," and "Reach to Recovery" programs are all designed to help cancer clients: ■ 1. Choose treatment centers. ■ 2. Find fi nancial help. ■ 3. Obtain home health care. ■ 4. Cope with cancer.

4. These American Cancer Society- sponsored groups are designed to educate clients and their families experiencing cancer about the disease and methods of coping positively with it. These are selfhelp and support groups monitored by professionals and cancer survivors who have undergone a training course that helps them to facilitate small groups.

A 52-year-old client is scheduled for a total abdominal hysterectomy for cervical cancer. The nurse's discussion regarding the client's feelings and the potential impact of this procedure on her sexuality should include which of the following questions? ■ 1. "All women experience sexual problems with this surgical procedure. Do you have any questions?" ■ 2. "When can I schedule an appointment with you and your partner to discuss any issues either of you may have regarding sexuality?" ■ 3. "Do you anticipate any problems with sex related to your scheduled hysterectomy?" ■ 4. "Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?"

4. This question introduces some basic information and allows for support for the client who may be experiencing some sexuality concerns. Not all women experience sexual problems after undergoing a hysterectomy. Assuming that the client will want to schedule an appointment with her partner is inappropriate and may embarrass her. Simply asking the client whether she expects to have problems with sex is too abrupt and does not provide any information.

The nurse-manager on the oncology unit wants to address the issue of correct documentation of the effectiveness of analgesia medication within 30 minutes after administration. What should the nurse-manager do fi rst? ■ 1. Change the policy of documentation to 45 minutes. ■ 2. Consult the pharmacist. ■ 3. Consult the nurses on the evening shift where documentation of analgesia is the greatest problem. ■ 4. Complete a brief quality improvement study and chart audit to document the rate of adherence to the policy and the pattern of documentation over shifts.

4. To determine the cause of this problem, a quality improvement study should be conducted. Before implementing solutions to a problem, the precise issues in the hospital system must be observed and documented. The Joint Commission requirements mandate documentation of the effectiveness of analgesia within 30 minutes after administration. It is not the pharmacist's role to provide consultation about documentation of drugs administered by nurses. Consulting the evening nurses may be helpful, but this is a systems issue of the entire unit and involves every registered nurse administering analgesia.

Which of the following terms describes the condition of a client who requires an increase in dosage to maintain adequate analgesia? ■ 1. Pseudoaddiction. ■ 2. Physical dependence. ■ 3. Psychological dependence. ■ 4. Drug tolerance.

4. Tolerance is a reduced responsiveness to the effect of any drug, which necessitates larger doses to achieve an equivalent effect of the initial dose. Pseudoaddiction is a term used to describe the iatrogenic syndrome of drug-seeking behavior that develops as a direct consequence of inadequate pain management. Physical dependence refers to the state in which an individual must take the substance to feel physically normal; not taking the drug results in withdrawal symptoms. Psychological dependence refers to an individual's need to derive an alteration in mood from a substance.

A 42-year-old husband and father of a 7-yearold girl and a 10-year-old boy is concerned about what he should tell his children regarding his wife's impending death from aggressive breast cancer. The nurse should: ■ 1. Refer the family to pastoral care services. ■ 2. Encourage the husband to come to terms with his own grief fi rst. ■ 3. Suggest that the children be told nothing until after death occurs. ■ 4. Begin education about strategies for communication with his children.

4. Without clear, consistent communication, the parent-child relationship may become strained during the illness and subsequent death of a parent. A great number of parents do not know how to communicate with their children, especially about diffi cult emotional topics at a time when they are also under great emotional stress. The nurse should begin by providing information and developmentally appropriate books about the grieving process for children. Referral to pastoral care services may be appropriate; however, the nurse's direct intervention of beginning education about strategies for communication will be of immediate and long-term benefi t. The grieving process cannot be rushed for the husband, nor should an opportunity for the father and children to communicate and grieve together be delayed. Excluding children from participating in the grieving ritual is not shielding them from the sorrow and sadness.

A 50-year-old female confirms chronic alcohol intake. This practice places the patient at risk for cancer in which organs? (Select all that apply.) a. Larynx b. Esophagus c. Liver d. Lung e. Brain f. Breast

A, B, C, F Rationale: Chronic alcohol consumption is a strong risk factor for colorectal cancer and cancer of the oral cavity, pharynx, hypopharynx, larynx, esophagus, liver, and breast. It is not associated with lung or brain cancer.

Brachytherapy is being used to treat cancer in a patient. What type of cancers responds well to brachytherapy? (Select all that apply.) a. Heart b. Cervix c. Head d. Neck e. Lung

B, C, D Rationale: Radiation sources can be temporarily placed into body cavities through a delivery method termed brachytherapy. Brachytherapy is useful in the treatment of cervical, prostate, and head and neck cancers.

A 65-year-old male was recently diagnosed with cancer. He is retired from construction work. Which of the following cancers is he likely to develop secondary to occupational hazards? a. Mesothelioma b. Bladder cancer c. Prostate cancer d. Bone cancer

a. Mesothelioma Rationale: One notable occupational factor is asbestos, which increases the risk of mesothelioma, lung cancer, and possibly others.

A 25-year-old male nursing student recently learned how diet can alter the chances of developing cancer. He tries to minimize his risks of developing the disease by ordering his steak: a. Rare b. Medium c. Medium-well d. Well done

a. Rare Rationale: The nursing student should order the steak rare, as the most relevant carcinogens produced by cooking are found in well-done charbroiled beef.

When a patient asks what types of cancers are associated with tobacco use, how should the nurse respond? a. Squamous and small cell adenocarcinomas b. Sarcoma and adenoma c. Melanoma and lymphoma d. Basal cell and lipoma

a. Squamous and small cell adenocarcinomas

Indicate on the illustration the area that correctly identifi es the position of the distal tip of a central line that is inserted into the subclavian vessel.

The distal tip of a central line lies in the superior vena cava or right atrium.

A nurse is palpating a female client's breast while assessing for breast disease. In the illustration below, indicate the area of the breast in which tumors are most commonly found.

The upper outer quadrant is the area of the breast in which most breast tumors are found. This area should be palpated thoroughly. Although breast tumors can be found in any area of the breast, including the nipple, the tumors are most often in the upper outer quadrant.

Which of the following compounds has been shown to increase the risk of cancer when used in combination with smoking? a. Alcohol b. Steroids c. Antihistamines d. Hypnotics

a. Alcohol Rationale: Tobacco use and alcohol use are known etiologic factors in head and neck cancers.

Chromosome aberrations and mutations in cells that were not directly irradiated are referred to as: a. Bystander effects b. Lethal mutation c. Delayed reproductive death d. Genetic instability

a. Bystander effects Rationale: The directly irradiated cells also can lead to genetic effects in so-called bystander cells or innocent cells. This is termed bystander effects. Lethal mutations occur when cells cannot reproduce, and this is not related to bystander effects. Lethal mutation and delayed reproductive death are similar phenomenon and are not related to bystander effects. Genetic instability is related to chromosomal instability.

A 25-year-old female was diagnosed with cervical cancer. History reveals she had many sexual partners, which she indicates is "too many to count." Which of the following is most likely to have caused her cancer? a. HPV-16 b. HPV-18 c. HPV-31 d. HPV-45

a. HPV-16 Rationale: HPV-16, in most countries, accounts for 50% to 60% of cervical cancer cases. HPV-18 accounts for 10% to12% of cervical cancer cases. HPV-31 accounts for 4% to 5% of cervical cancer cases. HPV-45 accounts for 4% to 5% of cervical cancer cases

A nurse is giving an example of inflammation as an etiology for cancer development. What is the best example the nurse should give? a. Pneumonia and lung cancer b. Ulcerative colitis and colon cancer c. Prostatic hypertrophy and prostate cancer d. Hypercholesteremia and leukemia

b. Ulcerative colitis and colon cancer Rationale: Individuals with a 10+ year history of ulcerative colitis have a 30-fold increase in developing colon cancer. There is no relationship between pneumonia and lung cancer, but there is a relationship between ulcerative colitis and colon cancer. There is no relationship between prostatic hypertrophy and cancer of the prostate, but there is a relationship between ulcerative colitis and colon cancer. There is no relationship between hypercholesteremia and leukemia, but there is a relationship between ulcerative colitis and colon cancer.

A patient asks when adjuvant chemotherapy is used. How should the nurse respond? Adjuvant chemotherapy treatment is used: a. As the primary treatment b. Before radiation therapy c. After surgical removal of a tumor d. In cancer with little risk of metastasis

c. After surgical removal of a tumor Rationale: Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of eliminating micrometastases.

A 50-year-old female develops skin cancer on her head and neck following years of sunbathing. Which of the following cancers is the most likely? a. Lymphoma b. Adenoma c. Basal cell carcinoma d. Leukemia

c. Basal cell carcinoma Rationale: Basal cell is related to UV radiation primarily from the sun.

A primary care provider is attempting to diagnose cancer and is looking for a tumor marker. Which of the following could be a possible marker? a. Red blood cells b. Apoptotic cells c. Enzymes d. Neurotransmitters

c. Enzymes Rationale: Tumor markers include hormones, enzymes, genes, antigens, and antibodies.

The role of physical activity in the prevention of colon cancer is identified by which of the following? a. It increases fluid loss leading to thirst and increased fluid intake, hydrating the colon. b. It increases blood supply thereby increasing oxygen to the colon. c. It increases gut motility thereby decreasing the time the bowel is exposed to mutagens. d. It increases the secretion of hydrochloric acid thereby killing mutants.

c. It increases gut motility thereby decreasing the time the bowel is exposed to mutagens.

Which statement indicates the patient has a good understanding of cancer risk factors? The most important environmental risk factor for cancer is exposure to: a. Ultraviolet (UV) radiation b. Radon c. Estrogen d. Cigarette smoke

d. Cigarette smoke Rationale: Cigarette smoking is carcinogenic and remains the most important cause of cancer.

A nurse recalls physical activity was shown to reduce the risk of which of the following types of cancer? a. Prostate b. Lung c. Bone d. Colon

d. Colon Rationale: Physical activity reduces the risk for breast and colon cancers.

When an oncologist is discussing the degree to which an organism's development is contingent on its environment, which of the following is the oncologist explaining? a. Transgenerational inheritance b. Epigenetics c. Histone modification d. Developmental plasticity

d. Developmental plasticity Rationale: Developmental plasticity is the degree to which an organism's development is contingent on its environment. Transgenerational inheritance is the heritable transmission to future generations of environmentally caused phenotypes. Epigenetics is the role of genes in development and disease. Histone modifications are changes in genetic acetylation.

Which of the following patients would be at greatest risk for basal cell carcinoma? a. Dark complexion, light eyes, underweight b. Light complexion, dark eyes, overweight c. Medium complexion, light eyes, smoker d. Light complexion, light eyes, fair hair

d. Light complexion, light eyes, fair hair Rationale: Individuals at risk for basal cell carcinoma are light complected and have light eyes and fair hair.