Chapter 19 Cancer Development

31. The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching? a. The pouch can be worn for up to 2 weeks before changing it. b. Decrease the amount of fluid intake to decrease the amount of drainage. c. The pouch can be removed when bowel movements have been regulated. d. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch.

✅. d. The ileostomy drainage is extremely irritating to the skin, so the skin must be cleaned and a new solid skin barrier and pouch applied as soon as a leak occurs to prevent skin damage. The pouch is usually worn for 4 to 7 days unless there is a leak. Because the initial drainage from the ileostomy is high, the fluid intake must be increased. The pouch must always be worn, as the liquid drainage, not formed bowel movements, is frequent.

35. In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? a. Semiliquid stools with increased fluid requirements b. Liquid stools in a pouch and increased fluid requirements c. Formed stools with a pouch, needing irrigation, but no fluid needs d. Semiformed stools in a pouch with the need to monitor fluid balance

✅. d. The patient with a transverse colostomy has semiliquid to semiformed stools needing a pouch and needs to have fluid balance monitored. The ascending colostomy has semiliquid stools needing a pouch and increased fluid. The ileostomy has liquid to semiliquid stools needing a pouch and increased fluid. The sigmoid colostomy has formed stools, may or may not need a pouch but will need irrigation, and no changes in fluid needs

30. When a patient returns to the clinical unit after an abdominal-perineal resection (APR), what should the nurse expect the patient to have? a. An abdominal dressing b. An abdominal wound and drains c. A temporary colostomy and drains d. A perineal wound, drains, and a stoma

✅. d. With an abdominal perineal-resection (APR), an abdominal incision is made, and the proximal sigmoid colon is brought through the abdominal wall and formed into a permanent colostomy. The patient is repositioned, a perineal incision is made, and the distal sigmoid colon, rectum, and anus are removed through the perineal incision, which may be closed or open and packed, and have drains.

6. The nurse caring for oncology clients knows that which form of metastasis is the most common? a. Bloodborne b. Direct invasion c. Lymphatic spread d. Via bone marrow

ANS: A Bloodborne metastasis is the most common way for cancer to metastasize. Direct invasion and lymphatic spread are other methods. Bone marrow is not a medium in which cancer spreads, although cancer can occur in the bone marrow.

A nurse is providing postoperative discharge teaching to a client following a panhysterectomy for uterine cancer. Which of the following information should the nurse include in the teaching? A. "You will need to continue to use some form of birth control for 6 months." B. "You might experience manifestations of menopause." C. "Do not lift anything heavier than 15 pounds." D. "Pain or burning on urination is an expected outcome of this surgery.

"You will need to continue to use some form of birth control for 6 months." The nurse should inform the client that, following a panhysterectomy, pregnancy is not possible and birth control is no longer required. B. "You might experience manifestations of menopause." The nurse should inform the client that a panhysterectomy includes the removal of the uterus and the ovaries that might cause manifestations of menopause to occur. Manifestations of menopause include hot flashes, night sweats, and vaginal dryness. "Do not lift anything heavier than 15 pounds." The nurse should inform the client to not lift anything heavier than 5 to 10 lbs. "Pain or burning on urination is an expected outcome of this surgery." The nurse should inform the client that pain or burning on urination is not an expected outcome of a panhysterectomy and to report these manifestations to the provider. Such manifestations can indicate a urinary tract infection. Medical-Surgical: Oncology

5. The client is diagnosed with chronic lymphocytic leukemia (CLL) after routine laboratory tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness? 1. CLL is not serious, and clients die from other causes first. 2. There are no symptoms with this form of leukemia. 3. This is a childhood illness and is self-limiting. 4. In early stages of CLL, the client may be asymptomatic.

1. All types of leukemia are serious and can cause death. The chronic types of leukemia are more insidious in the onset of symptoms and can have a slower progression of the disease. Chronic types of leukemia are more common in the adult population. 2. The symptoms may have a slower onset, but anemia causing fatigue and weakness and thrombocytopenia causing bleeding can be present (usually in the later stages of the dis- ease). Organ enlargement from infiltration may be present. Secondary symptoms of fe- ver, night sweats, and weight loss may also be present. 3. This disease is usually found in adults. ✅4. In this form of leukemia, the cells seem to escape apoptosis (programmed cell death), which results in many thousands of mature cells clogging the body. Because the cells are mature, the client may be asymptomatic in the early stages. TEST-TAKING HINT: The test taker can elimi- nate option "1" based on the words "not seri- ous"; common sense lets the test taker know this is not true. Content - Medical: Integrated Nursing Process - Diagnosis: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level - Analysis: Concept - Hematologic Regulation. Leukemia Hematological 5 Disorders. Davis success

19. Which test is considered diagnostic for Hodgkin's lymphoma? 1. A magnetic resonance image (MRI) of the chest. 2. A computed tomography (CT) scan of the cervical area. 3. An erythrocyte sedimentation rate (ESR). 4. A biopsy of the cervical lymph nodes.

1. An MRI of the chest area will determine numerous disease entities, but it cannot determine the specific morphology of Reed-Sternberg cells, which are diagnostic for Hodgkin's disease. 2. A CT scan will show tumor masses in the area, but it is not capable of pathological diagnosis. 3. ESR laboratory tests are sometimes used to monitor the progress of the treatment of Hodgkin's disease, but ESR levels can be elevated in several disease processes. ✅4. Cancers of all types are definitively diagnosed through biopsy procedures. The pathologist must identify Reed- Sternberg cells for a diagnosis of Hodgkin's disease. TEST-TAKING HINT: The test taker can elimi- nate the first three (3) answer options based on these tests giving general information on multiple diseases. A biopsy procedure of the involved tissues is the only procedure that provides a definitive diagnosis. Content - Medical: Integrated Nursing Process - Diagnosis: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Lymphoma Hematological 5 Disorders. Davis success

7. Which medication is contraindicated for a client diagnosed with leukemia? 1. Bactrim, a sulfa antibiotic. 2. Morphine, a narcotic analgesic. 3. Epogen, a biologic response modifier. 4. Gleevec, a genetic blocking agent.

1. Because of the ineffective or nonexistent WBCs (segmented neutrophils) characteristic of leukemia, the body cannot fight infections, and antibiotics are given to treat infections. 2. Leukemic infiltrations into the organs or the central nervous system cause pain. Morphine is the drug of choice for most clients with cancer. ✅3. Epogen is a biologic response modifier that stimulates the bone marrow to produce red blood cells. The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be generally ineffective for the desired results and would have the potential to stimulate malignant growth. 4. Gleevec is a drug that specifically works in leukemic cells to block the expression of the BCR-ABL protein, preventing the cells from growing and dividing. TEST-TAKING HINT: If the test taker were not familiar with the drug mentioned in option "4," then this option would not be a good choice. Options "1" and "2" are common drugs and should not be chosen as the answer unless the test take Leukemia Hematological 5 Disorders. Davis success

14. The client asks the nurse, "They say I have cancer. How can they tell if I have Hodgkin's disease from a biopsy?" The nurse's answer is based on which scientific rationale? 1. Biopsies are nuclear medicine scans that can detect cancer. 2. A biopsy is a laboratory test that detects cancer cells. 3. It determines which kind of cancer the client has. 4. The HCP takes a small piece out of the tumor and looks at the cells.

1. Biopsies are surgical procedures requiring needle aspiration or excision of the area; they are not nuclear medicine scans. 2. The biopsy specimen is sent to the pathology laboratory for the pathologist to determine the type of cell. "Laboratory test" refers to tests of body fluids performed by a laboratory technician. 3. A biopsy is used to determine if the client has cancer and, if so, what kind. However, this re- sponse does not answer the client's question. ✅4. A biopsy is the removal of cells from a mass and examination of the tissue under a microscope to determine if the cells are cancerous. Reed-Sternberg cells are diagnostic for Hodgkin's disease. If these cells are not found in the biopsy, the HCP can rebiopsy to make sure the specimen provided the needed sample or, depending on involvement of the tissue, diagnose a non-Hodgkin's lymphoma. TEST-TAKING HINT: Option "1" can be elimi- nated if the test taker knows what the word "biopsy" means. Option "3" does not answer the question and can be eliminated for this reason. Content - Medical: Integrated Nursing Process - Diagnosis: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level - Knowledge: Concept - Hematologic Regulation. Lymphoma Hematological 5 Disorders. Davis success

18. The nurse writes the problem of "grieving" for a client diagnosed with non-Hodgkin's lymphoma. Which collaborative intervention should be included in the plan of care? 1. Encourage the client to talk about feelings of loss. 2. Arrange for the family to plan a memorable outing. 3. Refer the client to the American Cancer Society's Dialogue group. 4. Have the chaplain visit with the client.

1. Encouraging the client to talk about his or her feelings is an independent nursing intervention. 2. Discussing activities that will make pleas- ant memories and planning a family outing improve the client's quality of life and assist the family in the grieving process after the client dies, but this is an independent nursing intervention. 3. Nurses can and do refer clients diagnosed with cancer to the American Cancer Society- sponsored groups independently. Dialogue is a group support meeting that focuses on deal- ing with the feelings associated with a cancer diagnosis. ✅4. Collaborative interventions involve other departments of the health-care facility. A chaplain is a referral that can be made, and the two disciplines should work together to provide the needed interventions Lymphoma Hematological 5 Disorders. Davis success

22. Which clinical manifestation of Stage I non- Hodgkin's lymphoma would the nurse expect to find when assessing the client? 1. Enlarged lymph tissue anywhere in the body. 2. Tender left upper quadrant. 3. No symptom in this stage. 4. Elevated B-cell lymphocytes on the CBC.

1. Enlarged lymph tissue would occur in Stage III or IV Hodgkin's lymphoma. 2. A tender left upper quadrant would indicate spleen infiltration and occurs at a later stage. ✅3. Stage I lymphoma presents with no symptoms; for this reason, clients are usually not diagnosed until the later stages of lymphoma. 4. B-cell lymphocytes are the usual lymphocytes involved in the development of lymphoma, but a serum blood test must be done specifi- cally to detect B cells. They are not tested on a CBC. Lymphoma Hematological 5 Disorders. Davis success

2. The nurse is assessing a client diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? 1. Fever and infections. 2. Nausea and vomiting. 3. Excessive energy and high platelet counts. 4. Cervical lymph node enlargement and positive acid-fast bacillus.

1. Fever and infection are hallmark symptoms of leukemia. They occur because the bone marrow is unable to produce white blood cells of the number and maturity needed to fight infection. 2. Nausea and vomiting are symptoms related to the treatment of cancer but not to the diagnosis of leukemia. 3. The clients are frequently fatigued and have low platelet counts. The platelet count is low as a result of the inability of the bone marrow to produce the needed cells. In some forms of leukemia, the bone marrow is not produc- ing cells at all, and in others, the bone mar- row is stuck producing tens of thousands of immature cells. 4. Cervical lymph node enlargement is associated with Hodgkin's lymphoma, and positive acid-fast bacillus is diagnostic for tuberculosis. Leukemia Hematological 5 Disorders. Davis success

16. Which client is at the highest risk for developing a lymphoma? 1. The client diagnosed with chronic lung disease who is taking a steroid. 2. The client diagnosed with breast cancer who has extensive lymph involvement. 3. The client who received a kidney transplant several years ago. 4. The client who has had ureteral stent placements for a neurogenic bladder.

1. Long-term steroid use suppresses the immune system and has many side effects, but it is not the highest risk for the development of lymphoma. 2. This client would be considered to be in late-stage breast cancer. Cancers are described by the original cancerous tissue. This client has breast cancer that has metas- tasized to the lymph system. ✅3.Clients who have received a transplant must take immunosuppressive medica- tions to prevent rejection of the organ. This immunosuppression blocks the immune system from protecting the body against cancers and other diseases. There is a high incidence of lymphoma among transplant recipients. 4. A neurogenic bladder is a benign disease; stent placement would not put a client at risk for cancer. Lymphoma Hematological 5 Disorders. Davis success

3. The client diagnosed with leukemia has central nervous system involvement. Which instruction should the nurse teach? 1. Sleep with the HOB elevated to prevent increased intracranial pressure. 2. Take an analgesic medication for pain only when the pain becomes severe. 3. Explain radiation therapy to the head may result in permanent hair loss. 4. Discuss end-of-life decisions prior to cognitive deterioration.

1. Sleeping with the head of the bed elevated might relieve some intracranial pressure, but it will not prevent increased intracranial pressure from occurring. 2. Analgesic medications for clients with can- cer are given on a scheduled basis with a fast-acting analgesic administered prn for breakthrough pain. ✅3. Radiation therapy to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. Radiation therapy has longer lasting side effects than chemotherapy. If the radiation therapy destroys the hair follicles, the hair will not grow back. 4. Cognitive deterioration does not usually occur. TEST-TAKING HINT: The test taker must be aware of the treatments used for the disease processes to answer this question but might eliminate option "2" because it violates basic principles of pain management. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Physiological Integrity, Physiological Adaptation: Cognitive Level Leukemia Hematological 5 Disorders. Davis success

8. The laboratory results for a male client diagnosed with leukemia include RBC count 2.1 × 106/mm3, WBC count 150 × 103/mm3, platelets 22 × 103/mm3, K+ 3.8 mEq/L, and Na+ 139 mEq/L. Based on these results, which intervention should the nurse teach the client? 1. Encourage the client to eat foods high in iron. 2. Instruct the client to use an electric razor when shaving. 3. Discuss the importance of limiting sodium in the diet. 4. Instruct the family to limit visits to once a week.

1. The anemia that occurs in leukemia is not related to iron deficiency and eating foods high in iron will not help. ✅2. The platelet count of 22 3 103/mm3 indicates a platelet count of 22,000. The definition of thrombocytopenia is a count less than 100,000. This client is at risk for bleeding. Bleeding precautions include decreasing the risk by using soft-bristle toothbrushes and electric razors and hold- ing all venipuncture sites for a minimum of five (5) minutes. 3. The sodium level is within normal limits. The client is encouraged to eat whatever he or she wants to eat unless some other disease process limits food choices. 4. The client is at risk for infection, but un- less the family or significant others are ill, they should be encouraged to visit whenever possible. TEST-TAKING HINT: The test taker could eliminate option "3" based on a normal laboratory value. The RBC, WBC, and platelet values are all not in normal range. The correct answer option must address one of these values. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level - Synthesis: Concept - Hematologic Regulation. Leukemia Hematological 5 Disorders. Davis success

10. Then urse and the licensed practical nurse(LPN) are caring for clients on an oncology floor. Which client should not be assigned to the LPN? 1. The client newly diagnosed with chronic lymphocytic leukemia. 2. The client who is four (4) hours postprocedure bone marrow biopsy. 3. The client who received two (2) units of (PRBCs) on the previous shift. 4. The client who is receiving multiple intravenous piggyback medications.

1. The newly diagnosed client will need to be taught about the disease and about treatment options. The registered nurse cannot delegate teaching to an LPN. 2. This client is postprocedure and could be cared for by the LPN. 3. This client has already received the blood products; this client requires routine moni- toring, which the LPN could perform. 4. The LPN can administer antibiotic medications. Leukemia Hematological 5 Disorders. Davis success

9. The nurse writes a nursing problem of "altered nutrition" for a client diagnosed with leukemia who has received a treatment regimen of chemotherapy and radiation. Which nursing intervention should be implemented? 1. Administer an antidiarrheal medication prior to meals. 2. Monitor the client's serum albumin levels. 3. Assess for signs and symptoms of infection. 4. Provide skin care to irradiated areas.

1. The nurse should administer an antiemetic prior to meals, not an antidiarrheal medication. ✅2. Serum albumin is a measure of the pro- tein content in the blood that is derived from the foods eaten; albumin monitors nutritional status. 3. Assessment of the nutritional status is indi- cated for this problem, not assessment of the signs and symptoms of infections. 4. This addresses an altered skin integrity problem. TEST-TAKING HINT: The stem of the question asks for interventions for "altered nutrition." Assessment is the first step of the nursing pro- cess, but option "3" is not assessing nutrition. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Physiological Integrity, Basic Care and Comfort: Cognitive Level - Application: Concept - Hematologic Regulation Leukemia Hematological 5 Disorders. Davis success

13. The client diagnosed with non-Hodgkin's lymphoma is scheduled for a lymphangiogram. Which information should the nurse teach? 1. The scan will identify any malignancy in the vascular system. 2. Radiopaque dye will be injected between the toes. 3. The test will be done similar to a cardiac angiogram. 4. The test will be completed in about five (5) minutes.

1. The scan detects abnormalities in the lym- phatic system, not the vascular system. ✅2. Dye is injected between the toes of both feet and then scans are performed in a few hours, at 24 hours, and then possibly once a day for several days. 3. Cardiac angiograms are performed through the femoral or brachial arteries and are com- pleted in one session. 4. The test takes 30 minutes to one (1) hour and then is repeated at intervals . TEST-TAKING HINT: The test taker must be aware of diagnostic tests used to diagnose specific diseases. Options "1" and "3" could be eliminated because of the words "vascu- lar" and "cardiac"; these words pertain to Lymphoma Hematological 5 Disorders. Davis success

⏺case study Bladder Cancer Patient Profile P.G. is a married, 61-year-old male bicycle mechanic who has been healthy all his life until he passed some blood in his urine. He saw a urologist at his wife's insistence. A urine specimen for cytology revealed atypical cells, and a diagnosis of bladder cancer was made following a cystoscopy with biopsy of the bladder tissue. The tumor was removed with a transurethral resection and laser cauterization. Intravesical therapy with bacille Calmette- Guérin (BCG), a weakened strain of Mycobacterium bovis, is planned. Subjective Data • Has smoked a pack of cigarettes a day since he was a teenager • Says he dreads having the chemotherapy because he has heard cancer drugs cause severe side effects Objective Data • Cystoscopy and biopsy results: moderately differentiated stage II tumor on the left lateral bladder wall with T1N0M0 pathologic stage • Continues to have gross hematuria 1. What does the staging of his bladder tumor indicate? 2. What care will the nurse provide for P.G. postoperatively? 3. What information and instructions would the nurse provide for P.G. about the intravesical therapy? 4. How can P.G. help prevent future bladder tumors from occurring? 5. How should the nurse explain the importance of follow-up cystoscopies? 6. What surgery may be indicated if the chemotherapy is not effective? 7. If surgery is needed, what factors will be considered in deciding the type of surgery? 8. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

1. The staging of bladder cancer is determined by the depth of invasion of the bladder wall and surrounding tissue. Stage II indicates that the tumor has grown into the muscle layer of the bladder but not passed completely through it. The TNM grading system indicates the characteristics of the primary tumor (T), the nodal involvement (N), and the presence of distant metastasis (M). (See Chapter 15 for TNM classification.) 2. Opioids and stool softeners may be used for a short time after the procedure. P.G. will be taught to drink a large volume of fluid and monitor the color and consistency of the urine. The urine will be pink at first but should not be red or contain clots. Seven to 10 days after the tumor resection, P.G. may observe dark red or rust-colored flecks in the urine from the healing tumor resection sites. 3. The drug will be instilled into the empty bladder via a urethral catheter at weekly intervals for 6 to 12 weeks. The drug must be retained for about 2 hours with P.G.'s position changed about every 15 minutes to ensure that the drug comes into maximum contact with all areas of the bladder. He may have irritative symptoms, such as frequency, urgency, and bladder spasms, in addition to hematuria during the weeks of treatment. Bacille Calmette-Guérin (BCG) therapy may cause flu-like symptoms or systemic infection because BCG stimulates the immune system rather than directly destroying cancer cells. The usual side effects of cancer chemotherapy are not experienced with BCG therapy or intravesical. chemotherapy. 4. P.G. should stop smoking; it is the only significant risk factor in his history. Increased daily fluid intake is also helpful. Routine follow-up care and possible maintenance therapy after the initial induction regimen may be beneficial, as there is a high rate of disease recurrence. 5. Follow-up cystoscopies on a regular basis are essential to evaluate the effectiveness of the treatment and detect any new tumors while they are in a superficial stage. Two-thirds of patients have tumor recurrence within 5 years, and nearly 95% have recurrence by 15 years. 6. A cystectomy with urinary diversion would be indicated. This could be an incontinent urinary diversion or a continent urinary diversion. 7. The patient's ability and readiness to learn must be considered. His anxiety and fear may affect the teaching. Psychosocial aspects of living with a stoma may affect the choice. Acceptance of the surgery and of alterations in body image is needed to ensure the patient's best adjustment. If a continent diversion is used, the patient must be able to catheterize the pouch every 4 to 6 hours and irrigate it as needed. Orthotopic bladder reconstruction may be considered if the cancer did not involve the bladder neck or urethra and the patient has normal renal and liver function, a longer than 1- to 2-year life expectancy, adequate motor skills, and no history of inflammatory bowel disease or colon cancer. Obese patients are not good candidates for orthotopic bladder reconstruction. 8. Nursing diagnoses • Anxiety; Etiology: unknown outcome • Impaired urinary system function; Etiology: effects of treatment • Acute pain; Etiology: effects of treatment • Risk for infection; Etiology: effects of treatment • Disturbed body image; Etiology: presence of stoma Collaborative problems Potential complication: bladder injury, impaired tissue integrity

12. The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assessment data warrant immediate intervention? 1. T 99, P 102, R 22, and BP 132/68. 2. Hyperplasia of the gums. 3. Weakness and fatigue. 4. Pain in the left upper quadrant.

1. These vital signs are not alarming. The vital signs are slightly elevated and indicate moni- toring at intervals, but they do not indicate an immediate need. 2. Hyperplasia of the gums is a symptom of my- eloid leukemia, but it is not an emergency. 3. Weakness and fatigue are symptoms of the disease and are expected. ✅4. Pain is expected, but it is a priority, and pain control measures should be implemented. TEST-TAKING HINT: If all the answer options contain expected events, the test taker must decide which is priority—and pain is a priority need. Content - Medical: Integrated Nursing Process - Assessment: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level Leukemia Hematological 5 Disorders. Davis success

20. Which client should be assigned to the experienced medical-surgical nurse who is in the first week of orientation to the oncology floor? 1. The client diagnosed with non-Hodgkin's lymphoma who is having daily radiation treatments. 2. The client diagnosed with Hodgkin's disease who is receiving combination chemotherapy. 3. The client diagnosed with leukemia who has petechiae covering both anterior and posterior body surfaces. 4. The client diagnosed with diffuse histolytic lymphoma who is to receive two (2) units of packed red blood cells

1. This client is receiving treatments that can have life-threatening side effects; the nurse is not experienced with this type of client 2. Chemotherapy is administered only by nurses who have received training in chemotherapy medications and their effects on the body and are aware of necessary safety precautions; this nurse is in the first week of orientation. 3. This is expected in a client with leukemia, but it indicates a severely low platelet count; a nurse with more experience should care for this client. ✅4. This client is receiving blood. The nurse with experience on a medical-surgical floor should be able to administer blood and blood products. TEST-TAKING HINT: The key to this question is the fact, although the nurse is an experi- enced medical-surgical nurse, the nurse is not experienced in oncology. The client who could receive a treatment on a medical-sur- gical floor should be assigned to the nurse. Content - Nursing Management: Integrated Nursing Process - Planning: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Synthesis: Concept - Nursing. Lymphoma Hematological 5 Disorders. Davis success

21. Which information about reproduction should be taught to the 27-year-old female client diagnosed with Hodgkin's disease? 1. The client's reproductive ability will be the same after treatment is completed. 2. The client should practice birth control for at least two (2) years following therapy. 3. All clients become sterile from the therapy and should plan to adopt. 4. The therapy will temporarily interfere with the client's menstrual cycle.

1. This is a false promise. Many clients undergo premature menopause as a result of the can- cer therapy. ✅2. The client should be taught to practice birth control during treatment and for at least two (2) years after treatment has ceased. The therapies used to treat the can- cer can cause cancer. Antineoplastic medica- tions are carcinogenic, and radiation therapy has proved to be a precursor to leukemia. A developing fetus would be subjected to the internal conditions of the mother. 3. Some clients—but not all—do become sterile. The client must understand the risks of ther- apy, but the nurse should give a realistic pic- ture of what the client can expect. It is correct procedure to tell the client the nurse does not know the absolute outcome of therapy. This is the ethical principle of veracity. 4. The therapy may interfere with the client's menses, but it may be temporary. Lymphoma Hematological 5 Disorders. Davis success

11. The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? 1. Infection. 2. Anemia. 3. Nutrition. 4. Grieving.

1. Treating infections, which require HCP orders for cultures and antibiotics, is a collaborative problem. 2. The treatment of anemia is a collaborative problem. 3. The provision of adequate nutrition requires collaboration among the nurse, HCP, and dietitian. ✅4.Grieving is an independent problem, and the nurse can assess and treat this prob- lem with or without collaboration. Leukemia Hematological 5 Disorders. Davis success

1. The nurse is caring for clients on an oncology unit. Which neutropenia precautions should be implemented? 1. Hold all venipuncture sites for at least five (5) minutes. 2. Limit fresh fruits and flowers. 3. Place all clients in reverse isolation. 4. Have the clients use a soft-bristle toothbrush.

1.This would be done for thrombocytopenia (low platelets), not neutropenia (low white blood cells). ✅2. Fresh fruits and flowers may carry bacte- ria or insects on the skin of the fruit or dirt on the flowers and leaves, so they are restricted around clients with low white blood cell counts. 3. Clients with severe neutropenia may be placed in reverse isolation, but not all clients with neutropenia will be placed in reverse isola- tion. Clients are at a greater risk for infecting themselves from endogenous fungi and bacte- ria than from being exposed to noninfectious individuals. 4. This is an intervention for thrombocytopenia. Leukemia Hematological 5 Disorders. Davis success

Question 1 of 18 A nurse is giving a group presentation on cancer prevention and factors that cause cancer. Which statement by a client indicates understanding the education provided? "Nearly 1/3 of cancers in the United States are related to tobacco use." "Red meat helps to prevent cancer development." "If I eat a healthy diet and exercise I will not develop cancer." "Most cancer is hereditary.

A nurse is giving a group presentation on cancer prevention and factors that cause cancer. Which statement by a client indicates understanding the education provided? CORRECT "Nearly 1/3 of cancers in the United States are related to tobacco use." Tobacco can be linked directly to the development of about 30% of all cancers in North America. Hereditary cancer occurs in a small percentage of the population. Increased red meat intake appears to increase risk of cancer development. A healthy diet and exercise can be helpful in self-care and overall health, but are not a guarantee that cancer will not develop "Red meat helps to prevent cancer development." Tobacco can be linked directly to the development of about 30% of all cancers in North America. Hereditary cancer occurs in a small percentage of the population. Increased red meat intake appears to increase risk of cancer development. A healthy diet and exercise can be helpful in self-care and overall health, but are not a guarantee that cancer will not develop "If I eat a healthy diet and exercise I will not develop cancer." Tobacco can be linked directly to the development of about 30% of all cancers in North America. Hereditary cancer occurs in a small percentage of the population. Increased red meat intake appears to increase risk of cancer development. A healthy diet and exercise can be helpful in self-care and overall health, but are not a guarantee that cancer will not develop INCORRECT "Most cancer is hereditary." Tobacco can be linked directly to the development of about 30% of all cancers in North America. Hereditary cancer occurs in a small percentage of the population. Increased red meat intake appears to increase risk of cancer development. A healthy diet and exercise can be helpful in self-care and overall health, but are not a guarantee that cancer will not develop

A nurse is providing discharge teaching to a client who is postoperative following a right mastectomy for breast cancer. The client will be discharged with two Jackson-Pratt drains. Which of the following information should the nurse include in the teaching? A. "Empty the drainage tubes once per day." B. "Showering is permitted before the drainage tubes are removed." C. "The drainage tubes often are removed at the same time as the stitches." D. "Do not begin exercising the arm until the provider removes the drainage tubes."

A. "Empty the drainage tubes once per day." The nurse should instruct the client to empty the drainage tubes and record the amount of drainage twice each day. B. "Showering is permitted before the drainage tubes are removed." The nurse should instruct the client to take baths until the provider removes the drainage tubes and stitches. ✅C. "The drainage tubes often are removed at the same time as the stitches." The nurse should instruct the client that the provider will remove the drainage tubes at the same time the stitches are removed, usually within 7 to 10 days. D. "Do not begin exercising the arm until the provider removes the drainage tubes." The nurse should instruct the client that normal use and nonstrenuous exercise is appropriate before the provider removes the drainage tubes. More strenuous exercise can begin following the removal of the drains. Medical-Surgical: Oncology

A nurse is providing discharge teaching to a client following open radical prostatectomy. The client is going home with an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching? A. "I will be able to take a tub bath in 1 week." B. "I will change the catheter drainage bag once each week." C. "I will use suppositories to prevent constipation." D. "I will regain my bladder control once the catheter is removed."

A. "I will be able to take a tub bath in 1 week." The nurse should instruct the client to shower rather than take a tub bath for 2 to 3 weeks following an open radical prostatectomy. ✅B . "I will change the catheter drainage bag once each week." The nurse should teach the client how to change the catheter drainage bag and to change the bag at least once each week. C. "I will use suppositories to prevent constipation." The nurse should instruct the client to use stool softeners, rather than suppositories, to control constipation. "I will regain my bladder control once the catheter is removed." The nurse should inform the client that bladder control might not return immediately and to practice Kegel exercises, which can help with incontinence. Urinary incontinence can last for 1 to 2 years following surgery. Medical-Surgical: Oncology

A hospice nurse is providing education about palliative care to the partner of a client who has end-stage liver cancer. Which of the following statements by the partner indicates an understanding of teaching? A. "I will do my best to try to get him to eat something." B. "I will lay him flat if his breathing becomes shallow." C. "I will use an electric blanket to keep him warm." D. "I will continue to talk to him even when he's sleeping."

A. "I will do my best to try to get him to eat something." The nurse should reinforce to the partner that the client who is approaching death often refuses nourishment and should not be forced to eat or drink. B. "I will lay him flat if his breathing becomes shallow." The nurse should reinforce to the partner that the client who is approaching death should be positioned with the head elevated or on the side. C. "I will use an electric blanket to keep him warm." The nurse should reinforce to the partner that the client should be covered with a blanket to keep the extremities warm, but not with an electric blanket. ✅D. "I will continue to talk to him even when he's sleeping." The nurse should reinforce to the partner that the client's hearing is thought to be the last sense to leave when in the dying process. Therefore, continue to softly communicate with the client. Medical-Surgical: Oncology

A nurse is providing preoperative teaching for a client who has colorectal cancer and is to undergo placement of a colostomy with a perineal wound. Which of the following statements by the client indicates an understanding of the teaching? A. "It will be a relief to not have any further rectal pain." B. "I will need to sit on a rubber donut when I am out of bed in the chair." C. "I can have only liquids for 2 days before the surgery." D. "The colostomy will start working about 7 days after the surgery."

A. "It will be a relief to not have any further rectal pain." Following placement of a colostomy with a perineal wound, rectal sensations such as pain and itching might occur even after healing of the client's surgical wound. B. "I will need to sit on a rubber donut when I am out of bed in the chair." The client should sit on foam pads or soft pillows and avoid the use of rubber donut devices, which increase pressure to the incisional site. ✅ C. "I can have only liquids for 2 days before the surgery." The client should consume a full or clear liquid diet for 24 to 48 hr before the surgery to decrease bulk. The client should consume a low-residue diet for several days prior to surgery to decrease peristalsis. D. "The colostomy will start working about 7 days after the surgery." Following surgery, the client's colostomy should begin to function within 2 to 4 days Medical-Surgical: Oncology

A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing skin cancer? A. Age over 60 B. Genetic predisposition C. Light-skinned race D. Overexposure to sun light

A. Age over 60 The nurse should recognize that the client being over the age of 60 is a risk factor for skin cancer; however, there is a greater risk factor than age for developing skin cancer. B. Genetic predisposition The nurse should recognize that the client having a genetic predisposition is a risk factor for skin cancer; however, there is a greater risk factor than genetic predisposition for developing skin cancer. C. Light-skinned race The nurse should recognize that the client being of a light-skinned race is a risk factor for skin cancer; however, there is a greater risk factor than race for developing skin cancer. ✅ D. Overexposure to sun light The nurse should apply the safety and risk reduction priority-setting framework when caring for this client. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should identify the client's overexposure to sun as being the greatest risk factor for developing skin cancer. Medical-Surgical: Oncology

A nurse is caring for a client who is postoperative following a urinary diversion to treat bladder cancer. Which of the following interventions should the nurse include in the plan of care? A. Empty the collection pouch when it is 2/3 full. B. Expect urine outflow into pouch to begin 1 to 2 days following surgery. C. Change the collection pouch in the early morning. D. Place an aspirin in the collection pouch to control odor.

A. Empty the collection pouch when it is 2/3 full. The nurse should empty the collection pouch when it is 1/3 full to prevent the excess weight of the urine causing the pouch to separate from the skin. B. Expect urine outflow into pouch to begin 1 to 2 days following surgery. The nurse should expect no delay in urinary output following surgery. The nurse should monitor hourly urine output in the immediate postoperative period. Monitoring is then every 4 to 8 hr. ✅C. Change the collection pouch in the early morning. The nurse should plan to change the urinary collection pouch in the early morning when urine output is reduced. Place an aspirin in the collection pouch to control odor. The nurse should not use an aspirin in the collection pouch to control odor, as this can cause an ulceration to the stoma. Medical-Surgical: Oncology

A nurse is admitting a client who has multiple myeloma and a white blood cell count of 2,200/mm3. Which of the following foods should the nurse prohibit the family members from bringing to the client? A. Fried chicken from a fast food restaurant B. A case of canned nutritional supplements C. A factory-sealed box of chocolates D. A fresh fruit basket

A. Fried chicken from a fast food restaurant Thoroughly cooked food products should not harbor bacteria that could be a potential source of infection for a client who has neutropenia. B. A case of canned nutritional supplements Canned nutritional supplements are permissible for the client. The nurse should dispose of any amount leftover to prevent bacterial growth from contamination. A factory-sealed box of chocolates A sealed box of candy should not harbor bacteria that could be a potential source of infection for a client who has neutropenia. ✅ D. A fresh fruit basket Raw fruits and vegetables are contraindicated for a client who has neutropenia, as the skin might harbor bacteria that can cause an infection. The nurse should prohibit these foods from entering the client's room. Medical-Surgical: Oncology

A nurse is caring for a client who is receiving chemotherapy to treat cancer. Which of the following adverse effects should the nurse anticipate from the chemotherapy? A. Gingival hyperplasia B. Hirsutism C. Pancytopenia D. Weight gain

A. Gingival hyperplasia Gingival hyperplasia, or overgrowth of gingival tissue in the mouth, is caused by poor oral hygiene and can lead to bacterial plaque and tartar accumulation, but it is not an adverse effect of chemotherapy. B. Hirsutism Hirsutism, or excessive body or facial hair, is generally caused by Cushing syndrome, especially in women. The nurse should expect to see alopecia, or hair loss, in a client who is receiving chemotherapy. ✅C. Pancytopenia Pancytopenia, a deficiency of WBCs, RBCs, and platelet counts, is an expected adverse effect of chemotherapy. D. Weight gain The client might have an inability or lack of desire to eat, causing weight loss due to the adverse effects of chemotherapy, such as a metallic taste in the mouth, nausea, and vomiting. Medical-Surgical: Oncology

A nurse is caring for a client who has lung cancer that has metastasized. Which of the following findings indicates the client is developing superior vena cava syndrome? A. Irregular cardiac rhythm B. Numbness in the hands C. Muscle cramps D. Facial edema

A. Irregular cardiac rhythm Superior vena cava syndrome is a partial occlusion of the superior vena cava. It leads to alterations in client's vascular flow, not cardiac arrhythmias. B. Numbness in the hands Superior vena cava syndrome is a partial occlusion of the superior vena cava. Numbness in the client's hands is a manifestation of spinal cord compression that can result if cancer spreads to the spinal cord. C. Muscle cramps Superior vena cava syndrome is a partial occlusion of the superior vena cava. Muscle cramps might indicate the client has syndrome of inappropriate antidiuretic hormone (SIADH) and might occur with cancer metastasis to the brain. ✅D.,Facial edema Superior vena cava syndrome is a medical emergency resulting from a partial occlusion of the superior vena cava, leading to a decreased blood flow through the vein. Most cases of superior vena cava syndrome are associated with cancers involving the client's upper chest, such as advanced lung and breast cancers and lymphoma. The earliest manifestations of superior vena cava syndrome are facial and upper extremity edema. Death can result if the compression is not corrected. Medical-Surgical: Oncology

A nurse is planning care for a client who has cancer and has developed thrombocytopenia following chemotherapy. Which of the following precautions should the nurse offer to minimize the adverse effects of thrombocytopenia? A. Monitor visitors for manifestations of infection. B. Remind the client to use an electric razor. C. Encourage frequent rest periods. D. Instruct the client to rinse mouth daily with normal saline.

A. Monitor visitors for manifestations of infection. The client has thrombocytopenia, not neutropenia. Neutropenia, a decreased WBC count, places a client at risk for infection, and the nurse should monitor for visitors who are ill. ✅B. Remind the client to use an electric razor. Thrombocytopenia is a decrease in the client's blood platelet count, which places the client at an increased risk of bleeding due to the blood's inability to clot. Therefore, the nurse should institute bleeding precautions, which includes the use of an electric razor. C. Encourage frequent rest periods. The client has thrombocytopenia, a decrease in the number of circulating RBCs, not iron-deficiency anemia. Iron-deficiency anemia necessitates the encouragement of frequent rest periods secondary to fatigue. D. Instruct the client to rinse mouth daily with normal saline. Stomatitis, an inflammation of the mucous membranes of the mouth, is not a manifestation of thrombocytopenia. The client who has stomatitis should use bland rinses and avoid commercial mouthwashes that contain alcohol, which might cause further breakdown to the oral tissue. Medical-Surgical: Oncology

A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing bladder cancer? A. The client is a hairdresser. B. The client uses tobacco. C. The client is over 60 years of age. D. The client has frequent urinary tract infections (UTIs)

A. The client is a hairdresser. The nurse should recognize that exposure to chemicals, such as those used in hairdressing, is a risk factor for developing bladder cancer; however, there is a greater risk to the client than chemical exposure. ✅B. The client uses tobacco. The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should identify the client's tobacco use as being the greatest risk factor for developing bladder cancer. C. The client is over 60 years of age. The nurse should recognize that being over the age of 60 is a risk factor for developing bladder cancer; however, there is a greater risk to the client than age. D. The client has frequent urinary tract infections (UTIs) The nurse should recognize that a history of UTIs is a risk factor for developing bladder cancer; however, there is a greater risk to the client than frequent UTIs. Medical-Surgical: Oncology

A nurse is caring for a client who has testicular cancer and is experiencing peripheral neuropathy as an adverse effect of chemotherapy. Which of the following client manifestations is an expected finding of peripheral neuropathy? A. Thinning of the scalp hair B. Tingling of the hands and feet C. Reduced ability to concentrate D. Sores in the mucous membranes

A. Thinning of the scalp hair Thinning of the scalp hair is alopecia, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy. ✅B. Tingling of the hands and feet Several chemotherapeutic agents might cause peripheral neuropathy. One of the major manifestations of peripheral neuropathy is numbness and tingling of an extremity. C. Reduced ability to concentrate The reduced ability to concentrate reflects cognitive changes, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy. D.Sores in the mucous membranes Sores in the mucous membranes is mucositis, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy. Medical-Surgical: Oncology

4. A group of nursing students has entered a futuristic science contest in which they have developed a cure for cancer. Which treatment would most likely be the winning entry? a. Artificial fibronectin infusion to maintain tight adhesion of cells b. Chromosome repair kit to halt rapid division of cancer cells c. Synthetic enzyme transfusion to allow rapid cellular migration d. Telomerase therapy to maintain chromosomal immortality

ANS: A Cancer cells do not have sufficient fibronectin and so do not maintain tight adhesion with other cells. This is part of the mechanism of metastasis. Chromosome alterations in cancer cells (aneuploidy) consist of having too many, too few, or altered chromosome pairs. This does not necessarily lead to rapid cellular division. Rapid cellular migration is part of metastasis. Immortality is a characteristic of cancer cells due to too much telomerase.

10. A client asks the nurse if eating only preservative- and dye-free foods will decrease cancer risk. What response by the nurse is best? a. Maybe; preservatives, dyes, and preparation methods may be risk factors. b. No; research studies have never shown those things to cause cancer. c. There are other things you can do that will more effectively lower your risk. d. Yes; preservatives and dyes are well known to be carcinogens.

ANS: A Dietary factors related to cancer development are poorly understood, although dietary practices are suspected to alter cancer risk. Suspected dietary risk factors include low fiber intake and a high intake of red meat or animal fat. Preservatives, preparation methods, and additives (dyes, flavorings, sweeteners) may have cancer- promoting effects. It is correct to say that other things can lower risk more effectively, but this does not give the client concrete information about how to do so, and also does not answer the clients question. DIF: Understanding/Comprehension REF: 379 KEY: Cancer| patient education| nutrition MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. The nurse working with oncology clients understands that interacting factors affect cancer development. Which factors does this include? (Select all that apply.) a. Exposure to carcinogens b. Genetic predisposition c. Immune function d. Normal doubling time e. State of euploidy

ANS: A, B, C The three interacting factors needed for cancer development are exposure to carcinogens, genetic predisposition, and immune function. DIF: Remembering/Knowledge REF: 378 KEY: Cancer| cellular regulation| pathophysiology MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

4. A nurse is providing community education on the seven warning signs of cancer. Which signs are included? (Select all that apply.) a. A sore that does not heal b. Changes in menstrual patterns c. Indigestion or trouble swallowing d. Near-daily abdominal pain e. Obvious change in a mole

ANS: A, B, C, E The seven warning signs for cancer can be remembered with the acronym CAUTION: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and nagging cough or hoarseness. Abdominal pain is not a warning sign. DIF: Remembering/Knowledge REF: 380

1. The nursing student learning about cancer development remembers characteristics of normal cells. Which characteristics does this include? (Select all that apply.) a. Differentiated function b. Large nucleus-to-cytoplasm ratio c. Loose adherence d. Nonmigratory e. Specific morphology

ANS: A, D, E Normal cells have the characteristics of differentiated function, nonmigratory, specific morphology, a smaller nucleus-to-cytoplasm ratio, tight adherence, and orderly and well-regulated growth. DIF: Remembering/Knowledge REF: 373 KEY: Cellular regulation| physiology MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

1. The student nurse learning about cellular regulation understands that which process occurs during the S phase of the cell cycle? a. Actual division (mitosis) b. Doubling of DNA c. Growing extra membrane d. No reproductive activity

ANS: B During the S phase, the cell must double its DNA content through DNA synthesis. Actual division, or mitosis, occurs during the M phase. Growing extra membrane occurs in the G1 phase. During the G0 phase, the cell is working but is not involved in any reproductive activity. DIF: Remembering/Knowledge REF: 373 KEY: Cellular regulation| physiology MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

3. A nurse is participating in primary prevention efforts directed against cancer. In which activities is this nurse most likely to engage? (Select all that apply.) a. Demonstrating breast self-examination methods to women b. Instructing people on the use of chemoprevention c. Providing vaccinations against certain cancers d. Screening teenage girls for cervical cancer e. Teaching teens the dangers of tanning booths

ANS: B, C, E Primary prevention aims to prevent the occurrence of a disease or disorder, in this case cancer. Secondary prevention includes screening and early diagnosis. Primary prevention activities include teaching people about chemoprevention, providing approved vaccinations to prevent cancer, and teaching teens the dangers of tanning beds. Breast examinations and screening for cervical cancer are secondary prevention methods. DIF: Applying/Application REF: 381 KEY: Cancer| primary prevention| secondary prevention| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

3. The nursing instructor explains the difference between normal cells and benign tumor cells. What information does the instructor provide about these cells? a. Benign tumors grow through invasion of other tissue. b. Benign tumors have lost their cellular regulation from contact inhibition. c. Growing in the wrong place or time is typical of benign tumors. d. The loss of characteristics of the parent cells is called anaplasia.

ANS: C Benign tumors are basically normal cells growing in the wrong place or at the wrong time. Benign cells grow through hyperplasia, not invasion. Benign tumor cells retain contact inhibition. Anaplasia is a characteristic of cancer cells. DIF: Understanding/Comprehension REF: 374 KEY: Cellular regulation| physiology| benign tumors MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

8. A nurse has taught a client about dietary changes that can reduce the chances of developing cancer. What statement by the client indicates the nurse needs to provide additional teaching? a. Foods high in vitamin A and vitamin C are important. b. Ill have to cut down on the amount of bacon I eat. c. Im so glad I dont have to give up my juicy steaks. d. Vegetables, fruit, and high-fiber grains are important.

ANS: C To decrease the risk of developing cancer, one should cut down on the consumption of red meats and animal fat. The other statements are correct. DIF: Remembering/Knowledge REF: 380 KEY: Cancer| patient education| nursing evaluation MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Health Promotion and Maintenance

7. A nurse is assessing a client with glioblastoma. What assessment is most important? a. Abdominal palpation b. Abdominal percussion c. Lung auscultation d. Neurologic examination

ANS: D A glioblastoma arises in the brain. The most important assessment for this client is the neurologic examination. DIF: Applying/Application REF: 377 KEY: Cancer| nursing assessment| neurologic system| neurologic assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. A student nurse asks the nursing instructor what apoptosis means. What response by the instructor is best? a. Growth by cells enlarging b. Having the normal number of chromosomes c. Inhibition of cell growth d. Programmed cell death

ANS: D Apoptosis is programmed cell death. With this characteristic, organs and tissues function with cells that are at their peak of performance. Growth by cells enlarging is hyperplasia. Having the normal number of chromosomes is euploidy. Inhibition of cell growth is contact inhibition. DIF: Understanding/Comprehension REF: 373 KEY: Cellular regulation| physiology MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

9. A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse reads in the clients chart that the cancer classification is TISN0M0. What does the nurse conclude about this clients cancer? a. The primary site of the cancer cannot be determined. b. Regional lymph nodes could not be assessed. c. There are multiple lymph nodes involved already. d. There are no distant metastases noted in the report.

ANS: D TIS stands for carcinoma in situ; N0 stands for no regional lymph node metastasis; and M0 stands for no distant metastasis. DIF: Remembering/Knowledge REF: 378 KEY: Cancer| laboratory values MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

5. Which statement about carcinogenesis is accurate? a. An initiated cell will always become clinical cancer. b. Cancer becomes a health problem once it is 1 cm in size. c. Normal hormones and proteins do not promote cancer growth. d. Tumor cells need to develop their own blood supply.

ANS: D Tumors need to develop their own blood supply through a process called angiogenesis. An initiated cell needs a promoter to continue its malignant path. Normal hormones and proteins in the body can act as promoters. A 1-cm tumor is a detectable size, but other events have to occur for it to become a health problem.

Psychosocial Integrity A client asks the nurse why his colorectal cancer is being tested for genetic mutations even though no one else in the family has ever had cancer. What is the nurse's best response? A. "Colorectal cancer is rare and most cases are caused by a genetic mutation." B. "The results of this testing will indicate what caused your cancer so you can avoid further exposure." C. "Many tumors have one or more genetic differences that can help determine the most effective treatment options." D. "Genetic testing of tumor cells can help determine the stage of your cancer and whether it has spread to other organs."

Answer: C Rationale: Genetic testing of tumor cells (not the client with cancer) can indicate genetic mutations that would increase the susceptibility of the tumor to being killed off or having its growth controlled by targeted therapy. It does not indicate cause, stage, or degree of metastasis. Colorectal cancer is very common. Although some colorectal cancers are caused by a genetic mutation, these cancers "run in families." Cognitive Level: Applying or higher Client needs category: ​Psychosocial Integrity Nursing Process Step: ​Intervention

A nurse in an oncology clinic is assessing a client who has early stage Hodgkin's lymphoma. Which of the following findings should the nurse expect? Bone and joint pain Enlarged lymph nodes Intermittent hematuria Productive cough

Bone and joint pain Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. Bone pain might indicate a late manifestation of metastasis. Bone and joint pain are early manifestations of leukemia and multiple myeloma, not Hodgkin's lymphoma. ✅Enlarged lymph nodes Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. The first manifestation of this cancer is often an enlarged painless lymph node, or nodes, which appear without a known cause. Other early manifestations include night sweats, unexplained weight loss, fever, and pruritus. The disease can spread to adjacent lymph nodes and later might spread outside the lymph nodes to the lungs, liver, bones, or bone marrow. The spread of Hodgkin's lymphoma is usually in an ordered pattern. Intermittent hematuria Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. Intermittent blood in the client's urine might indicate the manifestation of bladder cancer. Productive cough Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. A nonproductive cough might occur because of narrowed airways from swollen lymph glands. A productive cough might be an indication of lung cancer. Medical-Surgical: Oncology

19-1.​How does a mutation is a suppressor gene, such as BRCA1, increase the risk for cancer development? A.​Converting a proto-oncogene into an oncogene B.​Removing the control over proto-oncogene expression C.​Reducing the amount of cylins produced by the oncogenes D.​Inhibiting the recognition of abnormal cells through immunosurveillance

Correct Answer: B Rationale: Suppressor genes make products that control proto-oncogenes and prevent them from being over expressed, which would increase cell division. Thus when suppressor genes are mutated cellular regulation is lost and the increased cell division can result in cancer development. Conversion of a proto-oncogene to an oncogene requires a mutation in the proto-oncogene, not the suppressor gene. Health suppressor genes do control the amount of cyclins produced by either oncogenes or proto-oncogenes, so a mutated suppressor gene would lose this function. Suppressor genes do not interfere with the immunosurveillance performed by certain immune system cells to detect the presence of abnormal cells. Cognitive Level: Understanding Client needs category: ​Physiological Integrity Nursing Process Step: ​N/A

​A client's cancer is staged as T1, N2, M1 by the TNM classification system. How does the nurse interpret this report? A.​The client has two tumors that are nonresponsive to treatment. B.​The client has leukemia confined to the bone marrow. C.​The client has a 2 cm tumor with one regional lymph node involved and no distant metastasis. D.​The client has a small primary tumor extension into 3 lymph nodes and one site of distant metastasis.

Correct Answer:​D Rationale: T = primary tumor. A T1 indicates a primary tumor is detectable but still relatively small. N = regional lymph nodes. An N2 indicates regional lymph nodes are involved. M = distant metastasis. M1 indicates there is evidence of distant metastasis in at least one site. Cognitive level:​​Applying or higher Client Needs Category:​​Physiological integrity Nursing Process Step:​​Assessment

​Which statements made by a 62-year old client alerts the nurse to the possibility that the he may be at increased genetic risk for cancer development? Select all that apply. A.​An older aunt died from a brain tumor while she had breast cancer B.​He had two benign colon polyps removed during his most recent routine colonoscopy C.​His sister died from cancer of the appendix D.​His brother is being treated for breast cancer E.​His daughter 32-year-old daughter has been recently diagnosed with cervical cancer F.​One person in each of the previous three generations of his family has died from lung cancer

Correct Answers: C, D Rationale: Lung cancer and cervical cancers are considered environmentally-induced cancers and really do not have a specific genetic predisposition. The fact that one person in each of three family generations developed lung cancer is not considered excessive. Breast cancer in older women is common and often spreads to the brain. Two benign colon polyps are common for the age group and do not indicate a genetic predisposition. The brother has a cancer that is rare for the gender and the sister has an extremely rare cancer type. Both of these cancers in first degree relatives are "red flags" for the possibility of an increased genetic risk for cancer. Cognitive Level: Applying or higher Client needs category: ​​Health Promotion and Maintenance Nursing Process Step: ​​Assessment

Physiological Integrity An older client reports all of the following changes since his last checkup. Which changes alerts the nurse to the possibility of prostate cancer? Select all that apply. A. Bloody urine B. Constipation intermittent with diarrhea C. Erectile dysfunction D. Night sweats and fever E. Persistent pain in the lower back and legs F. Reduced urine stream

Correct Answers: D, E, F Rationale: Bloody urine is most associated with bladder cancer. Constipation/diarrhea and erectile dysfunction are not common signs or symptoms of prostate cancer. Reduced urine stream is associated with both prostate cancer and benign prostatic hyperplasia and is considered a red flag for prostate cancer when associated with other prostate cancer symptoms. Persistent pain in the lower back and legs, as well as night sweats and fever are associated with late stage prostate cancer. Cognitive Level: Applying or higher Client needs category: ​​Physiological Integrity Nursing Process Step: ​​Assessment

Physiological Integrity Which specific cancer types have a higher rate of occurrence among the Hispanic/Latino population of the U.S. compared with the nonHispanic white population? Select all that apply. A. Breast B. Colorectal C. Gall bladder D. Liver E. Lung F. Prostate G. Stomach

Correct Answers: ​C, D, G Rationale: The most common cancers in the United States among nonHispanic whites are breast, colorectal, lung, and prostate cancers. These occur at lower rates among Hispanic/Latino adults living in the U.S. However, the infection-associated cancers (gall bladder, liver, stomach) occur in this population at a higher rate. Cognitive Level: Understanding Client needs category:​​Physiological Integrity Nursing Process Step: ​​N/A

Question 10 of 18 A 40-year-old man who has a mother who was diagnosed with breast cancer at age 45, a father who was diagnosed with smoking-related lung cancer at age 55, a 33-year-old sister with breast cancer, and a 38-year-old sister with ovarian cancer, asks if he should be concerned for his cancer risk. What is the nurse's best response? A. "You have two first-degree relatives and two second-degree relatives with cancer, which increases your general risk for cancer." B."Your risk for breast cancer is increased; however, your risk for lung cancer is not affected by this history." C."Your risk for cancer is affected by your parents' cancer development; your sisters' cancers have no bearing on your risk." D. "Your risk is not affected by this family history because most of the cancers arose in female sex-associated tissues."

Question 10 of 18 A 40-year-old man who has a mother who was diagnosed with breast cancer at age 45, a father who was diagnosed with smoking-related lung cancer at age 55, a 33-year-old sister with breast cancer, and a 38-year-old sister with ovarian cancer, asks if he should be concerned for his cancer risk. What is the nurse's best response? INCORRECT "You have two first-degree relatives and two second-degree relatives with cancer, which increases your general risk for cancer." This man has four first-degree relatives with cancer, three of whom have cancers that are associated with a genetic risk. The fact that the sisters and mother were diagnosed at relatively young ages increases the likelihood of a genetic predisposition. The genetic association with these cancers also increases the risk for male members of the family. Lung cancer has not been found to have a genetic association. CORRECT "Your risk for breast cancer is increased; however, your risk for lung cancer is not affected by this history." This man has four first-degree relatives with cancer, three of whom have cancers that are associated with a genetic risk. The fact that the sisters and mother were diagnosed at relatively young ages increases the likelihood of a genetic predisposition. The genetic association with these cancers also increases the risk for male members of the family. Lung cancer has not been found to have a genetic association. "Your risk for cancer is affected by your parents' cancer development; your sisters' cancers have no bearing on your risk." This man has four first-degree relatives with cancer, three of whom have cancers that are associated with a genetic risk. The fact that the sisters and mother were diagnosed at relatively young ages increases the likelihood of a genetic predisposition. The genetic association with these cancers also increases the risk for male members of the family. Lung cancer has not been found to have a genetic association. "Your risk is not affected by this family history because most of the cancers arose in female sex-associated tissues." This man has four first-degree relatives with cancer, three of whom have cancers that are associated with a genetic risk. The fact that the sisters and mother were diagnosed at relatively young ages increases the likelihood of a genetic predisposition. The genetic association with these cancers also increases the risk for male members of the family. Lung cancer has not been found to have a genetic association.

Question 11 of 18 Which cancer screening or prevention activity is most important for the nurse to include when assessing a 20-year-old client who has Down syndrome? A. Assessing his skin for bruises and petechaie B. Teaching him how to perform self-testicular examination c. Testing his stool for occult blood D. Encouraging him to eat more fruit and leafy, green vegetables

Question 11 of 18 Which cancer screening or prevention activity is most important for the nurse to include when assessing a 20-year-old client who has Down syndrome? CORRECT Assessing his skin for bruises and petechaie All of the screening and prevention activities are appropriate; however, people with Down syndrome have an increased life-time risk for the development of leukemia. Teaching him how to perform self-testicular examination All of the screening and prevention activities are appropriate; however, people with Down syndrome have an increased life-time risk for the development of leukemia. Testing his stool for occult blood All of the screening and prevention activities are appropriate; however, people with Down syndrome have an increased life-time risk for the development of leukemia. INCORRECT Encouraging him to eat more fruit and leafy, green vegetables All of the screening and prevention activities are appropriate; however, people with Down syndrome have an increased life-time risk for the development of leukemia.

Question 12 of 18 An 85-year-old client tells the nurse that she does not perform breast self-exam because there is no history of breast cancer in her family. What is the nurse's best response? A. "Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased." B. "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age." C. "You are correct. Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you." D. "Examining your breasts once per year when you have your mammogram is sufficient screening for someone with your history."

Question 12 of 18 An 85-year-old client tells the nurse that she does not perform breast self-exam because there is no history of breast cancer in her family. What is the nurse's best response? "Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased." The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman. CORRECT "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age." The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman. "You are correct. Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you." The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman. "Examining your breasts once per year when you have your mammogram is sufficient screening for someone with your history." The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman.

Question 13 of 18 Which actions or behaviors represent to the nurse that a client is engaging in secondary cancer prevention practices? (Select all that apply.) Select all that apply. A. Eating a diet high in fiber and low in animal fat B. Having a health checkup, including chest x-ray, annually C. Obtaining a colonoscopy every 5 years D. Electing to have both ovaries removed a person who has a BRCA2 mutation E. Getting a mammogram or breast MRI annually F. Having a mole removed from the neck

Question 13 of 18 Which actions or behaviors represent to the nurse that a client is engaging in secondary cancer prevention practices? (Select all that apply.) Eating a diet high in fiber and low in animal fat Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection. CORRECT Having a health checkup, including chest x-ray, annually Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection. Obtaining a colonoscopy every 5 years Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection. INCORRECT Electing to have both ovaries removed a person who has a BRCA2 mutation Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection. CORRECT Getting a mammogram or breast MRI annually Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection. Having a mole removed from the neck Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection.

Question 14 of 18 Which conditions does the nurse teach a client are some of the seven warning signs of cancer? (Select all that apply.) Select all that apply. A. Heavy nosebleeds independent of trauma to the nasal mucosa B. Menstrual bleeding that has decreased C. Increased pigmentation with deeper coloring in a mole D. Difficulty starting the stream of urine for the past 6 months E. Indigestion regardless of food type eaten F. Thickening of breast tissue in one area

Question 14 of 18 Which conditions does the nurse teach a client are some of the seven warning signs of cancer? (Select all that apply.) CORRECT Heavy nosebleeds independent of trauma to the nasal mucosa The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy. Menstrual bleeding that has decreased The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy. CORRECT Increased pigmentation with deeper coloring in a mole The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy. CORRECT Difficulty starting the stream of urine for the past 6 months The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy. CORRECT Indigestion regardless of food type eaten The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy. CORRECT Thickening of breast tissue in one area The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy.

Question 15 of 18 Which common cancers will the nurse inform clients are related to tobacco use? (Select all that apply.) Select all that apply. A. Lung cancer B. Cancer of the larynx C. Bladder cancer D. Cancer of the tongue E. Skin cancer Cardiac cancer

Question 15 of 18 Which common cancers will the nurse inform clients are related to tobacco use? (Select all that apply.) CORRECT Lung cancer Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds. CORRECT Cancer of the larynx Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds. CORRECT Bladder cancer Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds. CORRECT Cancer of the tongue Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds. Skin cancer Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds. Cardiac cancer Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco. The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds.

Question 16 of 18 Which client assessment findings indicate to the nurse that leukemia may be present? (Select all that apply.) Select all that apply. A. Multiple bruises B. Night sweats C. Severe epistaxis D. Fever E. Frequent colds F. Fatigue

Question 16 of 18 Which client assessment findings indicate to the nurse that leukemia may be present? (Select all that apply.) CORRECT Multiple bruises All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client's platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection. CORRECT Night sweats All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client's platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection. Severe epistaxis All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client's platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection. CORRECT Fever All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client's platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection. CORRECT Frequent colds All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client's platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection. CORRECT Fatigue All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client's platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection.

Question 17 of 18 Which warning signs of cancer would the nurse specifically teach in a wellness course directed to a group of older adults? (Select all that apply.) Select all that apply. A. Persistent hoarseness B. Severe heartburn C. Chronic diarrhea D. Loss of skin turgor E. Curd-like vaginal discharge F. Difficulty swallowing with meals

Question 17 of 18 Which warning signs of cancer would the nurse specifically teach in a wellness course directed to a group of older adults? (Select all that apply.) CORRECT Persistent hoarseness Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging. CORRECT Severe heartburn Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging. CORRECT Chronic diarrhea Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging. Loss of skin turgor Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging. Curd-like vaginal discharge Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging. CORRECT Difficulty swallowing with meals Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging.

Question 18 of 18 A client is diagnosed with melanoma. Which areas would the nurse anticipate that this client's tumor might metastasize? (Select all that apply.) Select all that apply. A. Kidneys B. Liver C. Gastrointestinal tract D. Lymph nodes Brain Lung

Question 18 of 18 A client is diagnosed with melanoma. Which areas would the nurse anticipate that this client's tumor might metastasize? (Select all that apply.) Kidneys Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis. Liver Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis. CORRECT Gastrointestinal tract Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis. CORRECT Lymph nodes Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis. CORRECT Brain Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis. CORRECT Lungs Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis.

Question 2 of 18 How will the nurse interpret the finding on a client's pathology report that indicates a cancerous tumor is aneuploid? A. The tumor is completely undifferentiated. B. The tumor is fast growing. C. Metastasis has already occurred. D. The tumor has an abnormal number of chromosomes.

Question 2 of 18 How will the nurse interpret the finding on a client's pathology report that indicates a cancerous tumor is aneuploid? The tumor is completely undifferentiated. A tumor that is aneuploid has an abnormal number of chromosomes. It is not related to how fast the tumor cells divide or whether any differentiated functions remain. The presence or absence of metastasis cannot be determined by the ploidy. Although usually less differentiated cancers are aneuploid, that is not the definition. The tumor is fast growing. A tumor that is aneuploid has an abnormal number of chromosomes. It is not related to how fast the tumor cells divide or whether any differentiated functions remain. The presence or absence of metastasis cannot be determined by the ploidy. Although usually less differentiated cancers are aneuploid, that is not the definition. Metastasis has already occurred. A tumor that is aneuploid has an abnormal number of chromosomes. It is not related to how fast the tumor cells divide or whether any differentiated functions remain. The presence or absence of metastasis cannot be determined by the ploidy. Although usually less differentiated cancers are aneuploid, that is not the definition. CORRECT The tumor has an abnormal number of chromosomes. A tumor that is aneuploid has an abnormal number of chromosomes. It is not related to how fast the tumor cells divide or whether any differentiated functions remain. The presence or absence of metastasis cannot be determined by the ploidy. Although usually less differentiated cancers are aneuploid, that is not the definition.

Question 3 of 18 Which cancer type does the nurse interpret from a client's pathology report that indicates "stage 2 rhabdomyosarcoma"? A. Muscle B. Brain C. Bone D. Breast

Question 3 of 18 Which cancer type does the nurse interpret from a client's pathology report that indicates "stage 2 rhabdomyosarcoma"? Muscle The term "rhabdomyo" refers to bone and "sarcoma" refers to connective tissue. Thus an osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; bone cancer is an osteogenic sarcoma. Brain The term "rhabdomyo" refers to bone and "sarcoma" refers to connective tissue. Thus an osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; bone cancer is an osteogenic sarcoma. CORRECT Bone The term "rhabdomyo" refers to bone and "sarcoma" refers to connective tissue. Thus an osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; bone cancer is an osteogenic sarcoma. INCORRECT Breast The term "rhabdomyo" refers to bone and "sarcoma" refers to connective tissue. Thus an osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; bone cancer is an osteogenic sarcoma.

Question 4 of 18 What effect does a "passenger" mutation in a gene have on cancer development? A. Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies. B. These mutations enhance the effectiveness of carcinogens causing direct DNA damage of a normal cell, increasing the likelihood of cancer development. C. These mutations protect against cancer development by reversing the effects of initiation. Passenger mutations are another term for proto-oncogene gene mutations.

Question 4 of 18 What effect does a "passenger" mutation in a gene have on cancer development? CORRECT Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies. Although passenger mutations are often found along with driver mutations in later cancer stages, they appear to have no effect on initial cancer development or cancer cell survival. Their presence can be used to identify advanced cancer types and may also be used as "targets" for newer cancer therapies. These mutations enhance the effectiveness of carcinogens causing direct DNA damage of a normal cell, increasing the likelihood of cancer development. Although passenger mutations are often found along with driver mutations in later cancer stages, they appear to have no effect on initial cancer development or cancer cell survival. Their presence can be used to identify advanced cancer types and may also be used as "targets" for newer cancer therapies. These mutations protect against cancer development by reversing the effects of initiation. Although passenger mutations are often found along with driver mutations in later cancer stages, they appear to have no effect on initial cancer development or cancer cell survival. Their presence can be used to identify advanced cancer types and may also be used as "targets" for newer cancer therapies. Passenger mutations are another term for proto-oncogene gene mutations. Although passenger mutations are often found along with driver mutations in later cancer stages, they appear to have no effect on initial cancer development or cancer cell survival. Their presence can be used to identify advanced cancer types and may also be used as "targets" for newer cancer therapies.

Question 5 of 18 When educating a client with B-cell lymphoma, a nurse tells the client that a virus can contribute to the development of their cancer. Which virus is linked with B-cell lymphoma? A. Human lymphotrophic virus type II B. Human papilloma virus C. Epstein-Barr virus D. Hepatitis B virus

Question 5 of 18 When educating a client with B-cell lymphoma, a nurse tells the client that a virus can contribute to the development of their cancer. Which virus is linked with B-cell lymphoma? Human lymphotrophic virus type II The Epstein-Barr virus has been associated with B-cell lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma. Hepatitis B, human papilloma virus, and human lymphotrophic virus type II are associated with other cancers, but are not associated with B-cell lymphoma INCORRECT Human papilloma virus The Epstein-Barr virus has been associated with B-cell lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma. Hepatitis B, human papilloma virus, and human lymphotrophic virus type II are associated with other cancers, but are not associated with B-cell lymphoma CORRECT Epstein-Barr virus The Epstein-Barr virus has been associated with B-cell lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma. Hepatitis B, human papilloma virus, and human lymphotrophic virus type II are associated with other cancers, but are not associated with B-cell lymphoma Hepatitis B virus The Epstein-Barr virus has been associated with B-cell lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma. Hepatitis B, human papilloma virus, and human lymphotrophic virus type II are associated with other cancers, but are not associated with B-cell lymphoma

Question 6 of 18 How will the nurse interpret the finding on a client's pathology report that a cancerous tumor has a mitotic index of 8%? A. The tumor has not yet undergone carcinogenesis. B. The tumor is slow-growing. C. Metastasis has already occurred. D. The tumor has an abnormal number of chromosomes

Question 6 of 18 How will the nurse interpret the finding on a client's pathology report that a cancerous tumor has a mitotic index of 8%? The tumor has not yet undergone carcinogenesis. A mitotic index of 8% means that only 8% of the cells within the tumor sample are actively dividing, which represents a low or slow growth rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index. CORRECT The tumor is slow-growing. A mitotic index of 8% means that only 8% of the cells within the tumor sample are actively dividing, which represents a low or slow growth rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index. Metastasis has already occurred. A mitotic index of 8% means that only 8% of the cells within the tumor sample are actively dividing, which represents a low or slow growth rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index. INCORRECT The tumor has an abnormal number of chromosomes. A mitotic index of 8% means that only 8% of the cells within the tumor sample are actively dividing, which represents a low or slow growth rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index.

Question 7 of 18 Which client circumstance would prompt the nurse to create a three-generation pedigree to more fully explore the possibility of increased genetic risk for cancer? A. Smoked for 20 years but quit 5 years ago B. Personal history of excessive sun exposure C. Most family adult members are overweight D. Strong family history of breast cancer

Question 7 of 18 Which client circumstance would prompt the nurse to create a three-generation pedigree to more fully explore the possibility of increased genetic risk for cancer? Smoked for 20 years but quit 5 years ago Breast cancer can be sporadic, familial, or inherited. A strong family history of breast cancer should be explored for ages of breast cancer discovery and any discernable pattern of inheritance to determine whether genetic counseling is appropriate. Smoking, sun exposure, and being overweight are all considered environmental or lifestyle risks for cancer, not an increased genetic risk. Personal history of excessive sun exposure Breast cancer can be sporadic, familial, or inherited. A strong family history of breast cancer should be explored for ages of breast cancer discovery and any discernable pattern of inheritance to determine whether genetic counseling is appropriate. Smoking, sun exposure, and being overweight are all considered environmental or lifestyle risks for cancer, not an increased genetic risk. Most family adult members are overweight Breast cancer can be sporadic, familial, or inherited. A strong family history of breast cancer should be explored for ages of breast cancer discovery and any discernable pattern of inheritance to determine whether genetic counseling is appropriate. Smoking, sun exposure, and being overweight are all considered environmental or lifestyle risks for cancer, not an increased genetic risk. CORRECT Strong family history of breast cancer Breast cancer can be sporadic, familial, or inherited. A strong family history of breast cancer should be explored for ages of breast cancer discovery and any discernable pattern of inheritance to determine whether genetic counseling is appropriate. Smoking, sun exposure, and being overweight are all considered environmental or lifestyle risks for cancer, not an increased genetic risk.

Question 8 of 18 The nurse recognizes that a client's hemangiosarcoma originated in which tissue? A. Epithelial tissue B. Blood vessel C. Skeletal muscle D. Cartila

Question 8 of 18 The nurse recognizes that a client's hemangiosarcoma originated in which tissue? Epithelial tissue The prefix "hemangio-" is included when cancers of the blood vessel are named. The prefix "rhabdo-" is used when cancers of the skeletal muscle are named. The prefix "chondro-" is included when cancers of cartilage are named. The prefix "adeno-" is included when cancers of epithelial tissues are named. CORRECT Blood vessel The prefix "hemangio-" is included when cancers of the blood vessel are named. The prefix "rhabdo-" is used when cancers of the skeletal muscle are named. The prefix "chondro-" is included when cancers of cartilage are named. The prefix "adeno-" is included when cancers of epithelial tissues are named. Skeletal muscle The prefix "hemangio-" is included when cancers of the blood vessel are named. The prefix "rhabdo-" is used when cancers of the skeletal muscle are named. The prefix "chondro-" is included when cancers of cartilage are named. The prefix "adeno-" is included when cancers of epithelial tissues are named. INCORRECT Cartilage The prefix "hemangio-" is included when cancers of the blood vessel are named. The prefix "rhabdo-" is used when cancers of the skeletal muscle are named. The prefix "chondro-" is included when cancers of cartilage are named. The prefix "adeno-" is included when cancers of epithelial tissues are named.

Question 9 of 18 A 74-year-old client recovering from lung cancer surgery tells the nurse, "I don't understand why I have lung cancer. I have never even touched a cigarette." Which factor may explain the cause? A. A history of cardiac disease B. Advancing age C. A history of military service D. A diagnosis of diabetes

Question 9 of 18 A 74-year-old client recovering from lung cancer surgery tells the nurse, "I don't understand why I have lung cancer. I have never even touched a cigarette." Which factor may explain the cause? A history of cardiac disease Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases and therefore risk for overgrowth of cancer cells increases. Diabetes is not known to cause lung cancer. A history of cardiac disease does not predispose a person to lung cancer, nor does a history of military service. CORRECT Advancing age Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases and therefore risk for overgrowth of cancer cells increases. Diabetes is not known to cause lung cancer. A history of cardiac disease does not predispose a person to lung cancer, nor does a history of military service. A history of military service Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases and therefore risk for overgrowth of cancer cells increases. Diabetes is not known to cause lung cancer. A history of cardiac disease does not predispose a person to lung cancer, nor does a history of military service. INCORRECT A diagnosis of diabetes Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases and therefore risk for overgrowth of cancer cells increases. Diabetes is not known to cause lung cancer. A history of cardiac disease does not predispose a person to lung cancer, nor does a history of military service.

A nurse is monitoring a client who has cancer and is receiving chemotherapy by peripheral IV infusion. The client reports pain at the insertion site and the nurse notes fluid leaking around the catheter. Which of the following actions should the nurse take first? Take a photograph of the peripheral IV site. Obtain and record the client's vital signs. Stop the infusion. Identify all medications administered through the IV site for the past 24 hr.

Take a photograph of the peripheral IV site. The nurse should take a photograph of the IV site for documentation of potential harm from extravasation; however, there is another action that is the priority. Obtain and record the client's vital signs. The nurse should take and record the client's vital signs following extravasation of a chemotherapy agent; however, there is another action that is the priority. ✅Stop the infusion. The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. Many chemotherapy medications are vesicants that can cause extensive tissue damage if extravasation occurs; therefore, the nurse's first action should be to stop the infusion immediately. Identify all medications administered through the IV site for the past 24 hr. The nurse should identify all medications administered through the IV site for the past 24 hr; however, there is another action that is the priority. Medical-Surgical: Oncology

A nurse is providing teaching to a client who has cancer and is receiving external radiation therapy. Which of the following statements by the client indicates an understanding of the teaching? A. "I need to protect the area from sunlight." B. "I'm going to apply a heating pad to the area after each treatment." C"I'll massage the area once per day." D. "I'll wash the markings off after each therapy treatment."

✅ A "I need to protect the area from sunlight." To prevent skin irritation and subsequent breakdown, the nurse should instruct the client to protect areas of skin from sunlight that receive radiation. "I'm going to apply a heating pad to the area after each treatment." The nurse should instruct the client to avoid heat exposure to the radiated area, which might lead to skin breakdown. "I'll massage the area once per day." The nurse should instruct the client that massage can cause friction to the radiated skin, which might lead to skin breakdown. "I'll wash the markings off after each therapy treatment." The nurse should instruct the client that external radiation sites are marked to indicate the exact area to receive the radiation therapy. Washing off the markings is contraindicated. Medical-Surgical: Oncology

32. On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find? a. Hyperactive, high-pitched bowel sounds b. A brick-red, puffy stoma that oozes blood c. A purplish stoma, shiny and moist with mucus d. A small amount of liquid fecal drainage from the stoma

✅ b. A normal new colostomy stoma should appear rose to brick-red, have mild to moderate edema, and have a small amount of bleeding or oozing of blood when touched. A purplish stoma indicates inadequate blood supply and should be reported. Bowel sounds after extensive bowel surgery will be diminished or absent. The colostomy will not have any fecal drainage for 2 to 4 days, but there may be some earlier mucus or serosanguineous drainage.

A."Take your temperature twice each day." B.,"You may return to school if you feel strong enough." C. "It is important to always wear shoes." D. "Clean your toothbrush weekly with isopropyl alcohol." E. "Avoid using tampons."

✅"Take your temperature twice each day" is correct. Clients who are postoperative bone marrow transplants are immunosuppressed and should continually monitor for manifestations of infection. A temperature that is greater than 38° C (100° F) should be reported immediately to the provider. "You may return to school if you feel strong enough" is incorrect. Clients who have had a bone marrow transplant are immunosuppressed. They should avoid crowds, such as those encountered at school, a mall, or a movie theater. They will also require time at home to recover and should limit their visitors to individuals who are healthy. ✅"It is important to always wear shoes" is correct. A client who had a bone marrow transplant is immunosuppressed and should wear shoes to prevent injury and decrease the risk for infection. "Clean your toothbrush weekly with isopropyl alcohol" is incorrect. Alcohol can cause trauma and irritation to the gums and tissues. Rinsing the toothbrush in a weak bleach solution or placing in it in the dishwasher weekly are safer alternatives. ✅"Avoid using tampons" is correct. The use of tampons is discouraged because they can disrupt the mucosal layer of the vagina and, if left in too long, can support the growth of bacteria. Medical-Surgical: Oncology

27. When obtaining a nursing history from a patient with cancer of the urinary system, what does the nurse recognize as a risk factor associated with both kidney cancer and bladder cancer? a. Smoking b. Family history of cancer c. Chronic use of phenacetin d. Chronic, recurrent kidney stones

✅. a. Both cancer of the kidney and cancer of the bladder are associated with smoking. A family history of renal cancer is a risk factor for kidney cancer. Cancer of the bladder has been associated with long-term indwelling catheters, recurrent renal calculi (often bladder), and chronic lower UTIs.

36. The nurse plans teaching for the patient with a colostomy, but the patient refuses to look at the nurse or the stoma, stating, "I just can't see myself with this thing." What is the best nursing intervention for this patient? a. Encourage the patient to share concerns and ask questions. b. Refer the patient to a chaplain to help cope with this situation. c. Explain that there is nothing the patient can do about it and must take care of it. d. Tell the patient that learning about it will prevent stool leaking and the sounds of flatus.

✅. a. Encouraging the patient to share concerns and ask questions will help the patient begin to adapt to living with the colostomy. The other options do not support the patient and do not portray the nurse's focus on helping the patient or treating the patient as an individual.

23. Priority Decision: A patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively? a. Measure the ileostomy output to determine the status of the patient's fluid balance. b. Change the ileostomy appliance every 3 to 4 hours to prevent leakage of drainage onto the skin. c. Emphasize that the ostomy is temporary and the ileum will be reconnected when the large bowel heals. d. Teach the patient about the high-fiber, low-carbohydrate diet required to maintain normal ileostomy drainage.

✅. a. Initial output from a newly formed ileostomy may be as high as 1500 to 2000 mL daily, and intake and output must be accurately monitored for fluid and electrolyte imbalance. Ileostomy bags may have to be emptied every 3 to 4 hours, but the appliance should not be changed for several days unless there is leakage onto the skin. A terminal ileum stoma is permanent, and the entire colon has been removed. A return to a normal, presurgical diet is the goal for the patient with an ileostomy, with restrictions based only on the patient's individual tolerances.

35. During assessment of the patient who had an open nephrectomy, what should the nurse expect to find? a. Shallow, slow respirations b. Clear breath sounds in all lung fields c. Decreased breath sounds in the lower left lobe d. Decreased breath sounds in the right and left lower lobes

✅. b. A nephrectomy incision is usually in the flank, just below the diaphragm or in the abdominal area. Although the patient is reluctant to breathe deeply because of incisional pain, the lungs should be clear. Decreased sounds and shallow respirations are abnormal and would require intervention.

38. A teaching plan developed by the nurse for the patient with a new ileal conduit includes instructions to do what? a. Clean the skin around the stoma with alcohol every day. b. Use a wick to keep the skin dry during appliance changes. c. Use sterile supplies and technique during care of the stoma. d. Change the appliance every day and wash it with soap and warm water.

✅. b. Because the stoma continuously drains urine, a wick formed of a rolled-up 4 × 4 gauze or a tampon is held against the stoma to absorb the urine while the skin is cleaned and a new appliance is attached. The skin is cleaned with warm water only because soap and other agents cause drying and irritation. Clean, not sterile, technique is used. The appliance should be left in place for as long as possible before it loosens and allows leakage onto the skin, perhaps up to 14 days.

22. A patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. On initial postoperative assessment of the patient, what should the nurse expect to find? a. A rectal tube set to low continuous suction b. A loop ileostomy with a plastic rod to hold it in place c. A colostomy stoma with an NG tube in place to provide pouch irrigations d. A permanent ileostomy stoma in the right lower quadrant of the abdomen

✅. b. The initial procedure for a total proctocolectomy with ileal pouch and anal anastomosis includes a colectomy, rectal mucosectomy, ileal reservoir construction, ileoanal anastomosis, and a temporary ileostomy. A loop ileostomy is the most common temporary ileostomy, and it may be held in place with a plastic rod for the first week. A rectal tube to suction is not indicated in any of the surgical procedures for ulcerative colitis. A colostomy is not used, and an NG tube would not be used to irrigate the pouch. A permanent ileostomy stoma would be expected following a total proctocolectomy with a permanent ileostomy.

28. During a routine screening colonoscopy on a 56-year-old patient, a rectosigmoidal polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. What is the best response by the nurse? a. "It is very rare for polyps to become malignant, but you should continue to have routine colonoscopies." b. "Individuals with polyps have a 100% lifetime risk of developing colorectal cancer and at an earlier age than those without polyps." c. "All polyps are abnormal and should be removed, but the risk for cancer depends on the type and if malignant changes are present." d. "All polyps are premalignant and a source of most colon cancer. You will need to have a colonoscopy every 6 months to check for new polyps."

✅. c. Although all polyps are abnormal growths, the most common type of polyp (hyperplastic) is nonneoplastic, as are inflammatory, lipomas, and juvenile polyps. However, adenomatous polyps are characterized by neoplastic changes in the epithelium, and about 85% of colorectal cancers (CRCs) arise from these polyps. Only patients with a family history of familial adenomatous polyposis (FAP) have close to a 100% lifetime risk of developing CRC and are at greater risk for other cancers.

28. Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur? a. The only treatment modalities for the disease are palliative. b. Diagnostic tests are not available to detect tumors before they metastasize. c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced. d. Early metastasis to the brain impairs the patient's ability to recognize the seriousness of symptoms.

✅. c. There are no early characteristic symptoms of cancer of the kidney, and gross hematuria, flank pain, and a palpable mass do not occur until the disease is advanced. The treatment of choice is a partial or radical nephrectomy, which can be successful in early disease. Radiation is palliative. Many kidney cancers are diagnosed as incidental imaging findings. The most common sites of metastases are the lungs, liver, and long bones.

33. Collaboration: The registered nurse (RN) coordinating the care for a patient who is 2 days postoperative following an abdominal-perineal resection (APR) with colostomy may delegate which interventions to the licensed practical nurse (LPN) (select all that apply)? a. Irrigate the colostomy. b. Teach ostomy and skin care. c. Assess and document stoma appearance. d. Monitor and record the volume, color, and odor of the drainage. e. Empty the ostomy bag and measure and record the amount of drainage.

✅. d, e. The LPN can monitor and record observations related to the drainage and can measure and record the amount. The LPN could also monitor the skin around the stoma for breakdown. LPNs can irrigate a colostomy in a stable patient, but this patient is only 2 days postoperative. The other actions are responsibilities of the RN (teaching, assessing stoma, and developing a care plan)

34. A male patient who is scheduled for an abdominal-perineal resection (APR) is worried about his sexuality. What is the best nursing intervention for this patient? a. Have the patient's sexual partner reassure the patient that he is still desirable. b. Reassure the patient that sexual function will return when healing is complete. c. Remind the patient that affection can be expressed in ways other than through sexual intercourse. d. Explain that physical and emotional factors can affect sexual function but not necessarily the patient's sexuality.

✅. d. Sexual dysfunction may result from an APR, but the nurse should discuss with the patient that different nerve pathways affect erection, ejaculation, and orgasm and that a dysfunction of one does not mean total sexual dysfunction and also that an alteration in sexual activity does not have to alter sexuality. Referral to a wound, ostomy, and continence nurse (WOCN) would also be helpful. Simple reassurance of desirability and ignoring concerns about sexual function do not help the patient regain positive feelings of sexuality.

37. A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient's first postoperative day, what should the nurse plan to do? a. Measure and fit the stoma for a permanent appliance. b. Encourage high oral intake to flush mucus from the conduit. c. Teach the patient to self-catheterize the stoma every 4 to 6 hours. d. Empty the drainage bag every 2 to 3 hours and measure the urinary output.

✅. d. Urine drains continuously from an ileal conduit and the drainage bag must be emptied every 2 to 3 hours and measured to ensure adequate urinary output. Fitting for a permanent appliance is not done until the stoma shrinks to its normal size in a few weeks. With an ileal conduit, mucus is present in the urine because it is secreted by the ileal segment as a result of the irritating effect of the urine, but the surgery causes paralytic ileus and the patient will be NPO for several days postoperatively. Self- catheterization is performed when patients have formation of a continent Kock pouch.

39. Collaboration: When working with patients with urologic problems, which nursing interventions could be delegated to unlicensed assistive personnel (UAP) (select all that apply)? a. Assess the need for catheterization. b. Use bladder scanner to estimate residual urine. c. Teach patient pelvic floor muscle (Kegel) exercises. d. Insert indwelling catheter for uncomplicated patient. e. Assist incontinent patient to commode at regular intervals. f. Provide perineal care with soap and water around a urinary catheter.

✅. e, f. The UAP may assist the incontinent patient to void at regular intervals and provide perineal care. An RN should perform the assessments and teaching. The LPN/VN will do bladder scanning. In long-term care and rehabilitation facilities, UAP may use bladder scanners after they are trained.

6. The client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? 1. A left shift in the white blood cell (WBC) count differential. 2. A large number of WBCs that decreases after the administration of antibiotics. 3. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level. 4. Red blood cells (RBCs) that are larger than normal.

✅1. A left shift indicates immature white blood cells are being produced andreleased into the circulating blood volume. This should be investigated for the malignant process of leukemia. 2. Leukocytosis (elevated WBCs) is normal in the presence of an infection, but it should decrease as the infection clears. 3. A low hemoglobin and hematocrit level indi- cates anemia and can be caused by a number of factors. Anemia does occur in leukemia, but it is not diagnostic for leukemia. 4. Red blood cells larger than normal occur in macrocytic anemias (vitamin B12 and folic acid deficiency). They are not characteristic of leukemia. TEST-TAKING HINT: The test taker should rec- ognize elevated WBCs resolve with antibiot- ics as an infection. Option "3" is not specific enough to be the correct answer. Content - Medical: Integrated Nursing Process - Assessment: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level - Analysis: Concept - Hematologic Regulation. Leukemia Hematological 5 Disorders. Davis success

23. The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a bone marrow transplantation unit. Which nursing task should the nurse delegate? 1. Take the hourly vital signs on a client receiving blood transfusions. 2. Monitor the infusion of antineoplastic medications. 3. Transcribe the HCP's orders onto the medication administration record (MAR). 4. Determine the client's response to the therapy.

✅1. After the first 15 minutes during which the client tolerates the blood transfusion, it is appropriate to ask the UAP to take the vital signs as long as the UAP has been given specific parameters for the vital signs. Any vital sign outside the normal parameters must have an intervention by the nurse. 2. Antineoplastic medication infusions must be monitored by a chemotherapy-certified, com- petent nurse. 3. This is the responsibility of the ward secre- tary or the nurse, not the unlicensed assistive personnel. 4. This represents the evaluation portion of the nursing process and cannot be delegated. Lymphoma Hematological 5 Disorders. Davis success

4. The client diagnosed with leukemia is scheduled for bone marrow transplantation. Which interventions should be implemented to prepare the client for this procedure? Select all that apply. 1. Administer high-dose chemotherapy. 2. Teach the client about autologous transfusions. 3. Have the family members' HLA typed. 4. Monitor the complete blood cell count daily. 5. Provide central line care per protocol.

✅1. All of the bone marrow cells must be de- stroyed prior to "implanting" the healthy bone marrow. High-dose chemotherapy and full-body irradiation therapy are used to accomplish this. 2. Autologous transfusions are infusions from the client himself or herself. This client has a cancer involving blood tissue. To reinfuse the client's own tissues would be to purposefully give the client cancer cells. ✅3. The best bone marrow donor comes from an identical twin; next best comes from a sibling who matches. The most complica- tions occur from a matched unrelated do- nor (MUD). The client's body recognizes the marrow as foreign and tries to reject it, resulting in graft-versus-host disease (GVHD). ✅4. The CBC must be monitored daily to assess for infections, anemia, and thrombocytopenia. ✅5. Clients will have at least one multiple- line central venous access. These clients are seriously ill and require multiple transfusions and antibiotics. TEST-TAKING HINT: If the test taker knows the definition of "autologous," then option "2" could be eliminated. Content - Surgical: Integrated Nursing Process - Implementation: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level - Application: Concept - Hematologic Regulation. Leukemia Hematological 5 Disorders. Davis success

15. The nurse is admitting a client with a diagnosis of rule-out Hodgkin's lymphoma. Which assessment data support this diagnosis? 1. Night sweats and fever without "chills." 2. Edematous lymph nodes in the groin. 3. Malaise and complaints of an upset stomach. 4. Pain in the neck area after a fatty meal

✅1. Clients with Hodgkin's disease experience drenching diaphoresis,especiallyatnight; fever without chills; and unintentional weight loss. Early stage disease is indi- cated by a painless enlargement of a lymph node on one side of the neck (cervical area). Pruritus is also a common symptom. 2. Lymph node enlargement with Hodgkin's disease is in the neck area. 3. Malaise and stomach complaints are not associated with Hodgkin's disease. 4. Pain in the neck area at the site of the cancer occurs in some clients after the ingestion of alcohol. The cause for this is unknown. Lymphoma Hematological 5 Disorders. Davis success

A nurse is caring for a client who has breast cancer and is receiving a combination of chemotherapy medications. The client expresses confusion about the therapy. Which of the following explanations should the nurse provide? A. "The risk of renal toxicity is lessened when a combination of chemotherapy medications are used." B. "The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." C. "The use of more chemotherapy medications will shorten the time you have to be in treatment." D."The combination of chemotherapy medications will eliminate the potential for bone marrow sup

A. "The risk of renal toxicity is lessened when a combination of chemotherapy medications are used." A combination of chemotherapeutic agents does not lessen the incidence of renal toxicity. ✅B. "The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." Different chemotherapeutic agents act at various stages of cellular mitosis (division). By combining agents, medication therapy is more effective in stopping or slowing the growth of cancerous cells by interfering with their ability to multiply. C. "The use of more chemotherapy medications will shorten the time you have to be in treatment." A combination of chemotherapeutic agents does not ensure a shorter duration of treatment. D. "The combination of chemotherapy medications will eliminate the potential for bone marrow suppression." It is not entirely possible to eliminate the suppression of bone marrow caused by chemotherapeutic medications. The extent of bone marrow suppression is dependent on the specific medications being administered. Medical-Surgical: Oncology

A nurse is collecting a health history from a female client who is undergoing screening for breast cancer. Which of the following factors should the nurse identify for placing the client at the greatest risk for developing breast cancer? A. Obesity B. Oral contraceptive use C. Alcohol use D. Over 50 years of age

A. Obesity Obesity places a client at a low but increased risk for developing breast cancer. B. Oral contraceptive use Oral contraceptive use places a client at a low but increased risk of developing breast cancer. C. Alcohol use The risk from alcohol use is dose dependent. Consumption of 3 to 14 drinks a week causes a slight risk for developing breast cancer. ✅D. Over 50 years of age A female client whose age is over 50 years has a high increased risk for developing breast cancer. Medical-Surgical: Oncology

A nurse is obtaining a health history from a client who has cancer of the cervix. Which of the following manifestations should the nurse expect? A. Weight gain B. Oliguria C. Vaginal bleeding D. Back pain

Weight gain Unexplained weight loss is a manifestation of cancer of the cervix. Oliguria Dysuria is a manifestation of cancer of the cervix. ✅Vaginal bleeding The most common manifestation of cancer of the cervix is painless vaginal bleeding. Back pain Pelvic and chest pain are manifestations of cancer of the cervix. Medical-Surgical: Oncology

35. A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge? a. Chemotherapy is highly successful in the treatment of liver cancer. b. The patient will undergo surgery to remove the involved portions of the liver. c. Supportive care that is appropriate for all patients with severe liver damage is indicated. d. Metastatic cancer of the liver is more responsive to treatment than primary carcinoma of the liver.

c. Because the prognosis for cancer of the liver is poor and treatment is largely palliative, supportive nursing care isappropriate. The patient exhibits clinical manifestations of liver failure, as seen in any patient with advanced liver failure. Whether the cancer is primary or metastatic, there is usually a poor response to chemotherapy and surgery is indicated in the few patients that have localization of the tumor when there is no evidence of invasion of hepatic blood vessels.

29. When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about a. dietary intake. b. sports involvement. c. environmental exposure to carcinogens. d. long-term use of nonsteroidal antiinflammatory drugs (NSAIDs).

✅. a. A diet high in red meat and low in fruit and vegetable intake is associated with development of CRC, as are alcohol intake and smoking. Family and personal history of CRC also increases the risk. Other environmental agents are not known to be related to CRC. Long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with reduced CRC risk.

36. Which urinary diversion is a continent diversion created by formation of an ileal pouch with a stoma for catheterization? a. Kock pouch b. Ileal conduit c. Orthotopic neobladder d. Cutaneous ureterostomy

✅. a. The Kock pouch is a continent diversion created by formation of an ileal pouch with an external stoma requiring catheterization. Ileal conduit is the most common incontinent diversion using a stoma of resected ileum with implanted ureters. Orthotopic neobladder is a new bladder from a reshaped segment of intestine in the anatomic position of the bladder with urine discharged through the urethra. A cutaneous ureterostomy diverts the ureter from the bladder to the abdominal skin, but there is frequent scarring and strictures of the ureters, so ileal conduits are used more often. 37. d.

The 33-year-old client diagnosed with Stage IV Hodgkin's lymphoma is at the five (5)-year remission mark. Which information should the nurse teach the client? 1. Instruct the client to continue scheduled screenings for cancer. 2. Discuss the need for follow-up appointments every five (5) years. 3. Teach the client that the cancer risk is the same as for the general population. 4. Have the client talk with the family about funeral arrangements.

✅1. The five (5)-year mark is a time for cel- ebration for clients diagnosed with cancer, but the therapies can cause secondary malignancies and there may be a genetic predisposition for the client to develop cancer. The client should continue to be tested regularly. 2. Follow-up appointments should be at least yearly. 3. The client's risk for developing cancer has in- creased as a result of the therapies undergone for the lymphoma. 4. This client is in remission, and death is not imminent. TEST-TAKING HINT: The test taker should look at the time frames in the answer op- tions. It would be unusual for a client to be told to have a checkup every five (5) years. Option "4" can be eliminated by the stem, which clearly indicates the client is progress- ing well at the five (5)-year remission mark. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Health Promotion and Maintenance: Cognitive Level - Synthesis: Concept - Nursing Roles Lymphoma Hematological 5 Disorders. Davis success

17. The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse's best response? 1. Survival for Hodgkin's disease is relatively good with standard therapy. 2. Survival depends on becoming involved in an investigational therapy program. 3. Survival is poor, with more than 50% of clients dying within six (6) months. 4. Survival is fine for primary Hodgkin's, but secondary cancers occur within a year.

✅1. Up to 90% of clients respond well to standard treatment with chemotherapy and radiation therapy, and those who relapse usually respond to a change of chemotherapy medications. Survival depends on the individual client and the stage of disease at diagnosis. 2. Investigational therapy regimens would not be recommended for clients initially diag- nosed with Hodgkin's disease because of the expected prognosis with standard therapy. 3. Clients usually achieve a significantly longer survival rate than six (6) months. Many clients survive to develop long-term secondary complications. 4. Secondary cancers can occur as long as 20 years after a remission of the Hodgkin's disease has occurred. Lymphoma Hematological 5 Disorders. Davis success