CHAPTER 83 - CANCER

A client who has been diagnosed with multiple myeloma asks the nurse about the diagnosis. The nurse bases the response on which characteristic of the disorder?

Altered red blood cell production Altered production of lymph nodes Malignant exacerbation in the number of leukocytes -> Malignant proliferation of plasma cells and tumors within the bone

The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding would provide information about the massive cell destruction that occurs with the chemotherapy?

Anemia Decreased platelets -> Increased uric acid level Decreased leukocyte count

The nurse is caring for a client dying of ovarian cancer. During care, the client states, "If I can just live long enough to attend my daughter's graduation, I'll be ready to die." Which phase of coping is this client experiencing?

Anger Denial -> Bargaining Depression

The nurse is reinforcing instructions to a group of female clients about breast self-examination (BSE). When should the nurse instruct the client to perform this examination?

At the onset of menstruation Every month during ovulation Weekly at the same time of day -> One week after menstruation begins

The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a prostatectomy. The nurse should reinforce which discharge instruction?

Avoid driving a car for 1 week. Restrict fluid intake to prevent incontinence. -> Avoid lifting objects heavier than 20 pounds for at least 6 weeks. Notify the health care provider if small blood clots are noticed during urination.

A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period the nurse notes bloody drainage from the nasogastric (NG) tube. Which action should the nurse take?

Irrigate the NG tube. Measure abdominal girth. -> Continue to monitor the drainage. Ask the registered nurse to notify the health care provider (HCP) immediately.

A client with lung cancer receiving chemotherapy tells the nurse that the food on the meal tray tastes "funny." Which is the appropriate nursing intervention?

Keep the client NPO. -> Provide oral hygiene care frequently. Administer an antiemetic as prescribed. Consult with other health care providers regarding a prescription for parenteral nutrition.

A client with endometrial cancer is receiving doxorubicin (Adriamycin), an antineoplastic agent. The nurse should specifically collect data about which criterion?

Level of orientation Neuromuscular reflexes Pupillary response to light -> Hematological laboratory values

A client with ovarian cancer is scheduled to receive chemotherapy with cisplatin. The nurse assisting in caring for the client reviews the plan of care, expecting to note which intervention?

Restrict fluids. -> Encourage fluids. Encourage a low-fat diet. Encourage a high-protein diet.

A client is tentatively diagnosed with ovarian cancer. The nurse gathers data about which late symptom of this disease?

Mild digestive complaints -> Pelvic pain, anemia, and ascites Normal bowel and bladder function Vague lower abdominal discomfort

The nurse is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication related to the surgery?

Mild pain at the incisional site -> Arm edema on the operative side Sanguineous drainage in the drainage tube Complaints of decreased sensation near the operative site

The nurse is caring for a client with cancer receiving chemotherapy who has developed stomatitis. The nurse plans to give mouth care by using oral care agents and devices that meet which additional criterion?

The client requests them. They are readily available. The nurse prefers them. -> Care will be based on the severity of stomatitis.

A client is receiving chemotherapy that carries a risk of phototoxicity as an adverse effect. Which finding indicates that the client experienced this side effect?

Warts -> Erythema Petechiae Ecchymoses

The nurse is assisting in the care of a client diagnosed with multiple myeloma who has been prescribed an intravenous solution. Which finding would indicate a positive response to this treatment?

Weight increase of 1 kg -> Creatinine of 1 mg/dL Respirations of 18 breaths per minute White blood cell count of 6000/mm3

A client with liver cancer who is receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter. The nurse should try to limit which food that is most likely to have this taste for the client?

-> Beef Custard Potatoes Cantaloupe

The nurse is collecting data from a client suspected of having ovarian cancer. Which question should the nurse ask the client to elicit information specifically related to this disorder?

"Have you been having diarrhea?" "Have you had any abnormal vaginal bleeding?" "Are you having any excessive vaginal bleeding?" -> "Does your abdomen feel as though it is swollen?"

The nurse reviews the care plan of a client with cancer and notes that the client has a problem with adequate food intake related to side effects of therapy. In order to enhance appetite and nutrition, the nurse should offer which advice to the client?

-> Avoid strong-smelling foods. Avoid small, frequent meals. Avoid foods containing lean animal protein. Avoid foods that are served at room temperature.

The nurse is assisting in caring for a client with a diagnosis of bladder cancer who recently received chemotherapy. The nurse receives a telephone call from the laboratory who reports that the client's platelet count is 20,000/mm3. Based on this laboratory value, the nurse revises the plan of care and suggests including which intervention?

Return delivered fresh flowers to the florist. Instruct the client not to eat any fresh fruits. Monitor for signs of infection in the client. -> Monitor skin for the presence of petechiae.

The nurse has reinforced discharge instructions regarding home care to a client following a prostatectomy for cancer of the prostate. Which statement by the client indicates an understanding of the instructions?

"I can begin to drive my car in 1 week." -> "I should not lift anything over 20 pounds." "To prevent dribbling of urine, I need to limit my fluid intake to four glasses daily." "If I see any clots in my urine, I need to call the health care provider immediately."

The nurse provides skin care instructions to the client who is receiving external radiation therapy. Which statement by the client indicates the need for further teaching?

"I will handle the area gently." "I will wear loose-fitting clothing." "I will avoid the use of deodorants." -> "I will limit sun exposure to 1 hour daily."

The nurse is caring for a client who has undergone pelvic exenteration. In addressing psychosocial issues related to the surgery, which statement by the nurse should be therapeutic?

"Would you like to talk?" "You are looking good today." -> "How do you feel about your body?" "Will your family help you deal with this?"

A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is a priority in the nursing plan of care?

-> Monitor the client for bleeding. Monitor the client's temperature. Ambulate the client three times daily. Monitor the client for pathological fractures.

A nursing student is assisting in caring for a client with a lung tumor; the client will be having a pneumonectomy. The nursing instructor reviews the postoperative plan of care developed by the student and suggests deleting which item from the plan?

Avoiding complete lateral positioning Encouraging coughing and deep breathing Checking the surgical dressing for drainage -> Monitoring the closed chest tube drainage system

The client is hospitalized for the insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. Which is the immediate nursing action?

Call the health care provider (HCP). Reinsert the implant into the vagina. Pick up the implant with gloved hands and flush it down the toilet. -> Pick up the implant with long-handled forceps and place into a lead container.

A client with cancer has undergone a total abdominal hysterectomy and has a Foley catheter in place. The nurse should expect to note which type of urinary drainage immediately following this surgery?

Colorless Purulent Bright red -> Blood tinged

The nurse is monitoring a client with a diagnosis of cancer for signs and symptoms related to vena cava syndrome. The nurse understands that which is an early sign of this oncological emergency?

Confusion Disorientation -> Periorbital edema Mental status changes

When reviewing the health care record of a client with ovarian cancer, the nurse recognizes which sign/symptom as being a typical manifestation of the disease?

Diarrhea Hypermenorrhea Abnormal bleeding -> Abdominal distention

A client is receiving radiation therapy to the brain because of a diagnosis of a brain tumor. Which side/adverse effect does the nurse expect the client is likely to experience?

Diarrhea Pneumonitis Esophagitis -> Nausea and vomiting

The nurse is reinforcing client education regarding symptoms of testicular cancer. The nurse encourages the client to report which symptoms as being associated with testicular cancer? Select all that apply.

Difficulty attaining an erection Purulent discharge from the penis -> A grainy mass palpated in a testicle Difficulty initiating the urine stream -> An enlargement of one of the testes

The nurse is assisting in caring for a client with an inoperable lung tumor and helps develop a plan of care by addressing complications related to the disorder. The nurse includes monitoring for the early signs of vena cava syndrome in the plan. Which early sign of this oncological emergency should the nurse include monitoring for in the plan of care?

Disorientation Hand and arm edema -> Edema of the face and eyes Bluish skin discoloration around the mouth

The client is receiving external radiation to the neck for cancer of the larynx. The nurse monitors the client knowing that which is the most likely side/adverse effect of the external radiation?

Dyspnea Diarrhea -> Sore throat Constipation

The nurse is collecting data from a client with a history of bladder cancer. Which sign/symptom is the client most likely to report?

Dysuria -> Hematuria Urgency of urination Frequency of urination

The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further teaching if the client states an intention to take which action?

Eat a high-protein diet. Avoid exposure to sunlight. Wash the skin with a mild soap and pat it dry. -> Apply pressure on the radiated area to prevent bleeding.

The nurse is reinforcing instructions to a client on performing a testicular self-examination (TSE). Which instruction should the nurse provide to the client?

Examine the testicles while lying down. -> The best time for the examination is after a shower. Gently touch the testicle with one finger to feel for a growth. Testicular examinations should be done at least every 6 months.

The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which finding should the nurse most likely expect to find documented in the client's record?

Fatigue Weakness Weight gain -> Enlarged lymph nodes

The nurse is caring for a client after a mastectomy. Which nursing intervention should assist with preventing lymphedema of the affected arm?

Placing cool compresses on the affected arm -> Elevating the affected arm on a pillow above heart level Avoiding arm exercises during the immediate postoperative period Maintaining an intravenous (IV) insertion site below the antecubital area on the affected side

A nursing instructor asks a nursing student about the characteristics of Hodgkin's disease. The instructor determines that the student needs to read about the characteristics of this disease if the student states that which is an associated characteristic?

Presence of Reed-Sternberg cells -> Occurs most often in older adults Prognosis depends on the stage of the disease Involvement of lymph nodes, spleen, and liver

The nurse is assisting in planning care for a client with Hodgkin's disease who is neutropenic as a result of radiation and chemotherapy. Which actions would be included in the client's plan of care? Select all that apply.

Provide a diet high in protein. Monitor electrolyte levels daily. -> Monitor white blood cell counts daily. -> Ensure meticulous hand washing before caring for the client. -> Ask visitors with respiratory infection symptoms to not visit the client.

The nurse is assisting in caring for a client receiving chemotherapy. On review of the morning laboratory results, the nurse notes that the white blood cell count is extremely low, and the client is immediately placed on neutropenic precautions. The client's breakfast tray arrives, and the nurse inspects the meal and prepares to bring the tray into the client's room. Which action should the nurse take before bringing the meal to the client?

Remove the coffee from the breakfast tray. Ask the client if she feels like eating at this time. -> Remove the fresh orange from the breakfast tray. Call the dietary department and ask for disposable utensils.

The nurse is assisting with developing a plan of care for a client who is experiencing hematological toxicity as a result of chemotherapy. The nurse should suggest including which in the plan of care?

Restricting all visitors Restricting fluid intake -> Restricting fresh fruits and vegetables in the diet Inserting an indwelling urinary catheter to prevent skin breakdown

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which?

Rupture of the bladder -> The development of a vesicovaginal fistula Extreme stress resulting from the diagnosis of cancer Altered perineal sensation as a side effect of radiation therapy

The nurse is reviewing the record of a client with a diagnosis of cervical cancer. Which should the nurse expect to note in the client's record related to a risk factor associated with this type of cancer?

Single female, no children Intercourse with a single partner -> History of human papillomavirus Intercourse with circumcised males

The nurse is assisting with conducting a health-promotion program at a local school. The nurse determines that there is a need for further teaching if a student identifies which as a risk factor associated with cancer?

Stress Viral factors Exposure to radiation -> Low-fat and high-fiber diets

The health education nurse reinforces instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse reinforce to the client? Select all that apply.

Sunscreen should be applied every 8 hours. -> Use sunscreen when participating in outdoor activities. -> Wear a hat, opaque clothing, and sunglasses when in the sun. Avoid sun exposure in the late afternoon and early evening hours. -> Examine your body monthly for any lesions that may be suspicious.

The nurse determines that a client with which history is most at risk for endometrial cancer?

Surgical interventions Steroid replacement therapy -> Estrogen replacement therapy Occupational exposure to dust

The nurse is reviewing the laboratory results of a client who is receiving chemotherapy and notes that the platelet count is 10,000 cells/mm3. On the basis of this laboratory value, the nurse should collect which data as a priority?

Temperature Lung sounds Status of skin turgor -> Level of consciousness

A client has just been told by the health care provider about her diagnosis of breast cancer. The client responds, "Oh no, does this mean I'm going to die?" The nurse interprets which response as the client's initial reaction?

-> Fear Rage Denial Anxiety

The nurse is obtaining data from a client admitted with a diagnosis of bladder cancer. Which question should the nurse ask the client to determine if the client experienced the common symptom associated with this type of cancer?

-> "Do you notice any blood in the urine?" "Do you have frequency with urination?" "Do you commonly feel the urge to urinate?" "Do you experience any pain when you urinate?"

A cervical radiation implant is placed in the client for treatment of cervical cancer. Which activity would the nurse most likely expect to note in the health care provider's prescriptions?

-> Bed rest Out of bed in a chair Ambulate to the bathroom Out of bed and up to the bedside commode

The nurse is reviewing the laboratory results of a client with bladder cancer and bone metastasis and notes that the calcium level is 15 mg/dL. The nurse should take which appropriate action?

Document the findings. -> Notify the health care provider. Increase calcium-containing foods in the diet. Ask the unit secretary to file the report in the client's record.

The nurse reviews the care plan of a client with cancer undergoing chemotherapy. The nurse notes that the client has a concern about her appearance as a result of alopecia. The nurse plans to tell the client which information about hair loss and regrowth to assist the client in coping with this possible change?

Facial hair and body hair are generally not affected. -> Regrown hair may have a different color and texture. Hair loss is usually permanent for many older adult clients. Hair loss usually begins within 5 days of the first treatment.

A client who has just been told by the health care provider that she has breast cancer responds by stating, "Oh, no, this has to be a big mistake." The nurse interprets the client's initial response as which type of reaction?

Fear Rage -> Denial Anxiety

The nurse discusses the risk factors associated with gastric cancer as part of a health promotion program. The nurse determines that there is a need for further teaching if a member attending the program states that which factor is a risk?

History of gastric polyps History of pernicious anemia -> High meat and carbohydrate consumption A diet of smoked, highly salted, and spicy food

The nurse is assisting with conducting a health-promotion program to community members regarding testicular cancer. The nurse determines the need for further teaching if a community member states that which is a sign/symptom of testicular cancer?

-> Alopecia Back pain Painless testicular swelling A heavy sensation in the scrotum

The nurse is reviewing the record of a client admitted to the hospital for treatment of bladder cancer. Which risk factor related to this type of cancer should the nurse likely note in the client's record?

Female African American Recorded age of 35 years Occupation of computer analyzer -> Drinks coffee and smokes cigarettes

The nurse caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer is reinforcing discharge instructions to the client. Which statement by the client indicates the need for further teaching regarding care of the stoma?

"I need to protect the stoma from water." "I need to keep powders and sprays away from the stoma site." -> "I need to use an air conditioner to provide cool air to assist in breathing." "I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking."

The nurse is preparing a client for an intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. The nurse provides instructions to the client regarding the procedure. Which client statement indicates an understanding of this procedure?

"I need to stay on bed rest after the procedure is completed." "I will need to immediately urinate after the instillation is done." "After the instillation is done, I will need to retain the fluid for 30 minutes." -> "After the instillation is done, I will need to change position every 15 minutes from side to side."

A client is diagnosed as having a bowel tumor, and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy?

-> Biopsy of the tumor Abdominal ultrasound Computed tomography (CT) scan Magnetic resonance imaging (MRI)

The nurse is developing a plan of care for a client following a radical mastectomy and includes measures that will assist in preventing lymphedema of the affected arm. The nurse should include which action to prevent this complication?

-> Elevate the affected arm on a pillow. Place a cool compress on the affected arm. Place the affected arm in a dependent position. Instruct the client to avoid simple arm exercises in the affected arm.

A client receiving chemotherapy asks the nurse, "What will I do when my hair starts to fall out?" Which action by the nurse is appropriate?

-> Encourage her to select a wig. Offer to help her select a new hairstyle. Ignore the comment and change the subject. Tell her that people don't pay attention to such things anymore.

The nurse is assisting with developing a plan of care for the client with multiple myeloma. Which is a priority nursing intervention for this client?

-> Encouraging fluids Providing frequent oral care Coughing and deep breathing Monitoring the red blood cell count

The nurse reinforces instructions to the client about breast self-examination (BSE). The nurse instructs the client to lie down and examine the left breast. Which is the correct area for placing a pillow when examining the left breast?

-> Under the left shoulder Under the right scapula Under the right shoulder Under the small of the back

The nurse is reinforcing instructions to a community group regarding the risks and causes of bladder cancer. The nurse determines that there is a need for further teaching if a member of the community group makes which statement regarding this type of cancer?

-> It most often occurs in women. It is generally seen in clients who are older than 40 years of age. Environmental health hazards have been found to be a cause of this disease. Using cigarettes, artificial sweeteners, and coffee drinking can increase the risk for this cancer.

The nurse is assisting in developing a postoperative plan of care for a client following a mastectomy. Which interventions will be included in the plan of care? Select all that apply.

-> Place the affected arm on a pillow. -> Check the incision for signs of infection. Place a cold compress on the affected arm. Place the affected arm in a dependent position. -> Monitor and measure drainage in the collection device. Instruct the client to avoid arm exercises in the affected arm.

The nurse is reinforcing instructions to a client scheduled for conization in 1 week for the treatment of microinvasive cervical cancer. The procedure has been explained by the health care provider, and the nurse is reviewing the complications associated with the procedure. The nurse determines that the client needs further teaching if the client states that which is a complication of this procedure?

Infertility Infection Incompetent cervix -> Ovarian perforation

The nurse's teaching plan for a client with a family history of breast cancer should include which important item?

Monitoring for grief reactions Implementing measures to prevent cancer Teaching the importance of weight-bearing exercises -> Teaching the breast self-exam technique to be done every month

The nurse is collecting data from a client who is admitted to the hospital for diagnostic studies to rule out the presence of Hodgkin's disease. Which question should the nurse ask the client to elicit information specifically related to this disease?

"Are you tiring easily?" "Do you have any weakness?" "Have you gained any weight?" -> "Have you noticed any swollen lymph nodes?"

The nurse is reviewing the laboratory results of a client who has been diagnosed with multiple myeloma. Which finding should the nurse expect to note with this diagnosis?

-> Increased calcium level Increased white blood cells Decreased blood urea nitrogen (BUN) level Decreased number of plasma cells in the bone marrow

The nurse is caring for a client with metastatic lung cancer. The client was medicated 2 hours ago and now reports a new and sudden sharp pain in the back. The nurse appropriately interprets this finding as possibly indicating which complication?

Further metastasis A low pain threshold -> Spinal cord compression A need to adjust pain medication

The client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which may be prescribed to treat this complication? Select all that apply.

-> Radiation -> Chemotherapy Increased fluid intake -> Serum sodium blood levels Decreased oral sodium intake -> Medication that is antagonistic to antidiuretic hormone (ADH)

The nurse is preparing a client with a bowel tumor for surgery. The health care provider has informed the client that the surgery is palliative in the treatment of the tumor. Which rationale is the reason to perform this type of surgery?

-> To reduce pain To cure the client To eliminate high-risk factors To restore maximal function and appearance

The nurse is assisting in preparing a teaching plan of care for a client being discharged from the hospital following surgery for testicular cancer. Which instruction should the nurse suggest to include in the plan?

"You can climb stairs after 1 week." "You can be fitted for a prosthesis in 6 months." -> "An elevation in temperature should be reported to the health care provider." "You can lift heavy objects (those weighing 20 pounds or more) after 1 week following surgery."

The nurse is assisting in providing a session to community members about the risks associated with laryngeal cancer. Which statement by a client indicates an understanding of the risk factors?

-> "Exposure to airborne carcinogens can cause this type of cancer." "Alcohol consumption is not associated with this form of cancer." "Cigarette smoking does not contribute to the development of this type of cancer." "Persistent use of the voice is not associated with this type of cancer, unless spitting up of blood occurs."

The nurse is caring for a client with an internal radiation implant. The nurse should observe which principle?

-> Pregnant women are not allowed into the client's room. Limit the time with the client to 1 hour per 8-hour shift. Remove the dosimeter badge when entering the client's room. Individuals less than 16 years old are allowed in the room if they stay 6 feet away from the client.

The nurse when inspecting the stoma of a client following an ureterostomy 6 hours ago, notes that the stoma appears pale in color. Which interpretation does the nurse make based on this finding?

-> The vascular supply to the stoma is insufficient. This is a normal appearance of the stoma postoperatively. The client is experiencing a temporary fluid volume excess. The client's intravenous fluids require an immediate increase.

The nurse is reviewing the medical history of a client admitted to the hospital with a diagnosis of colorectal cancer. The nurse understands that which information documented in the medical history is an unassociated risk factor of this type of cancer?

Family history of colon cancer -> Regular consumption of a high-fiber diet A history of inflammatory bowel disease Regular consumption of a diet high in fats and carbohydrates

The nurse should monitor for which laboratory result as indicating an adverse reaction in the client with endometrial cancer who is receiving chemotherapy?

Hemoglobin 12.5 g/dL -> Platelet count 20,000 cells/mm3 Blood urea nitrogen 20 mg/dL White blood cell count 7000 cells/mm3