Chapters 16, 28, 43, 52 Quiz

The nurse should include which food choice when providing dietary teaching for a patient scheduled to receive external beam radiation for abdominal cancer? a. Whole wheat toast b. Cream of potato soup c. Roasted chicken d. Fresh fruit salad

C. To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products should also be avoided.

The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that a. the patient will need frequent eye examinations. b. hot flashes may occur with the medication. c. the patient should call if she notices ankle swelling. d. serum electrolyte levels will be drawn monthly.

C. Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab.

The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Colorectal screening b. Sunscreen use c. Tobacco use d. Mammography e. Pap testing

A, B, D, E The patient's age, gender, and history indicate a need for screening and/or teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy.

The nurse notes bilateral enlargement of the breasts during examination of a 62-year-old man. Which action should the nurse take first? a. Question the patient about medications being currently used. b. Refer the patient for mammography and biopsy of the breast tissue. c. Explain that this is a temporary condition due to hormonal changes. d. Teach the patient how to palpate the breast tissue for lumps.

A. The first action should be further assessment. Because gynecomastia is a possible side effect of drug therapy, asking about the current drug regimen is appropriate. The other actions may be needed, depending on the data that are obtained with further assessment.

The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient swims a mile 3 days a week. b. The patient showers everyday with a mild soap. c. The patient has a history of dental caries with amalgam fillings. d. The patient snacks frequently during the day.

A. The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan? a. Hospitalization will be required for several weeks after the stem cell transplant procedure is performed. b. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. c. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone. d. Donor bone marrow cells are transplanted through an incision into the sternum or hip bone.

A. The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room or incision required.

The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Document the amount of drainage every eight hours. b. Assess patient pain level associated with the chest tube. c. Check the water-seal chamber for the correct fluid level. d. Obtain samples of drainage for culture from the system.

A. UAP education includes documentation of intake and output. The other actions are within the scope of practice and education of licensed nursing personnel.

When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP has the patient rinse after meals with a saline solution. b. The UAP assists the patient to use dental floss after eating. c. The UAP puts fluoride toothpaste on the patient's toothbrush. d. The UAP adds baking soda to the patient's saline oral rinses.

B. Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? a. Generalized muscle aches b. Oral temperature of 100.6° F (38.1° C) c. Crackles heard at the lower scapular border d. Complaints of nausea and anorexia

C. Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.

An hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action is best for the nurse to take next? a. Assist the patient to deep breathe, cough, and use the incentive spirometer. b. Milk the chest tube gently to remove any clots. c. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine. d. Clamp the chest tube momentarily to check for the origin of the air leak.

C. The patient is unlikely to take deep breaths or cough until the pain level is lower. A chest tube output of 100 mL is not unusual in the first hour after thoracotomy and would not require milking of the chest tube. An air leak is expected in the initial postoperative period after thoracotomy.

A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? a. "Many patients with cancer live for a long time, so there is still time to plan for your children." b. "I'm sure you have friends that will take the children when you can't care for them." c. "Why don't we talk about the options you have for the care of your children?" d. "For now you need to concentrate on getting well and not worrying about your children."

C. This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's friends will take the children, more assessment information is needed before making plans.

A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? a. "You can wait until after surgery for teaching about pain management." b. "It is essential that you know enough to provide informed consent." c. "Tell me what you think is important to know about the surgery." d. "Many patients do better after surgery if they have more information."

C. This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences.

The nurse is caring for a patient who smokes 2 packs/day. To reduce the patient's risk of lung cancer, which action by the nurse is best? a. Teach the patient about the seven warning signs of cancer. b. Teach the patient about the use of annual chest x-rays for lung cancer screening. c. Plan to monitor the patient's carcinoembryonic antigen (CEA) level. d. Discuss the risks associated with cigarettes during every patient encounter.

D. Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems. A tumor must be at least 0.5 cm large before it is detectable by current screening methods and may already have metastasized by that time. Oncofetal antigens such as CEA may be used to monitor therapy or detect tumor reoccurrence, but are not helpful in screening for cancer. The seven warning signs of cancer are actually associated with fairly advanced disease.

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will indicate whether the cancer has spread to other organs." c. "The biopsy will determine how much longer I have to live." d. "The biopsy will help decide the treatment for my enlarged prostate."

D. A biopsy is used to determine whether the prostate enlargement is benign or malignant, and determines the type of treatment that will be needed. A biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life.

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he never knows what to say to help his wife. Which nursing diagnosis is most appropriate for the nurse to add to the plan of care? a. Compromised family coping related to disruption in lifestyle b. Dysfunctional family processes related to effect of illness on family members c. Impaired home maintenance related to perceived role changes d. Risk for caregiver role strain related to burdens of caregiving responsibilities

B The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest a change in lifestyle or its role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider? a. Poor oral intake b. Increase in carcinoembryonic antigen (CEA) c. Frequent loose stools d. Complaints of nausea and vomiting

B. An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified. The other patient findings are common adverse effects of chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy

The nurse provides discharge teaching for a 61-year-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful? a. "I will keep my left arm in a sling until the incision is healed." b. "I will avoid reaching over the stove with my left hand." c. "I will need to use my right arm and to rest the left one." d. "I will stop the left arm exercises if moving the arm is painful."

B. The patient should avoid any activity that might injure the left arm, such as reaching over a burner. If the left arm exercises are painful, analgesics should be used and the exercises continued in order to restore strength and range of motion. The left arm should be elevated at or above heart level and should be used to improve range of motion and function.

The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include? a. Another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir. b. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria. c. The patient will begin sitting in a chair at the bedside on the first postoperative day. d. The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively.

D. A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection. A permanent colostomy is created with this surgery. Sitting is contraindicated after an abdominal-perineal resection. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria.

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient complains of severe fatigue. b. Patient takes only 50% of meals and refuses snacks. c. Patient needs to void every hour during the day. d. Patient has audible crackles to the midline posterior chest.

D. Rapid fluid infusions may cause heart failure, especially in older patients. The other findings are common in patients who have cancer and/or are receiving chemotherapy.

A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should a. notify the surgeon about the stoma. b. monitor the stoma every 30 minutes. c. place ice packs around the stoma. d. document stoma assessment findings.

D. The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery, and an ice pack is not needed.

A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care? a. Arrange for delivery of a hospital bed to the patient's home. b. Minimize activity until the treatment is completed. c. Consult with a psychiatrist for treatment of depression. d. Establish time to take a short walk almost every day.

D. Walking programs are used to keep the patient active without excessive fatigue. Having a hospital bed does not necessarily address the fatigue. The better option is to stay as active as possible while combating fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility.

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Hold the medication unless a central venous line is available. d. Administer the chemotherapy through a small-bore catheter.

B Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapeutic drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.

During a well woman physical exam, a 43-year-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? a. "Have you ever had a breast injury?" b. "At what age did you start having menstrual periods?" c. "Is there a family history of fibrocystic breast changes?" d. "Do you currently smoke tobacco?"

B. Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

A 51-year-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a. only a small incision is needed, resulting in minimal breast pain and scarring. b. FNA is done in the outpatient clinic and results are available in 1 to 2 days. c. if the biopsy results are negative, no further diagnostic testing will be needed. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

B. FNA is done in outpatient settings and results are available in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound, but not by mammogram. Because the immobility of the breast lump suggests cancer, further testing will be done if the FNA is negative

A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Evaluating the patient's understanding of instructions about drain care b. Administering an analgesic 30 minutes before scheduled arm exercises c. Assessing the patient's range of motion for the left arm d. Teaching the patient how to avoid injury to the left arm

B. LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN level education and scope of practice

Which patient statement indicates that the nurse's teaching about tamoxifen (Nolvadex) has been effective? a. "I should contact you if I have hot flashes." b. "I will call if I have any eye problems." c. "I can expect to have leg cramps." d. "I will be taking the medication for 6 to 12 months."

B. Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Notify the health care provider about the symptoms. b. Assess for sensation and strength in the legs. c. Teach the patient how to use relaxation to reduce pain. d. Give the patient the prescribed PRN opioid.

B. Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression.

After a 48-year-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about a. raloxifene (Evista). b. tamoxifen (Nolvadex). c. estradiol (Estrace). d. trastuzumab (Herceptin).

B. Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.

A 36-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with symptoms. Which is most important to report to the health care provider? a. There is yellow-green discharge from the patient's right nipple. b. The lumps are larger and painful before the patient's menstrual period. c. The lumps are firm and most are in the upper outer breast quadrants. d. There is an area on the breast that is hot, pink, and tender to touch.

D. An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. The other information also will be reported, but these findings are typical in fibrocystic breasts.

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patient's bedpan. b. The UAP gives the patient an alcohol-containing mouthwash to use for oral care. c. The UAP places the patient's bedding in the laundry container in the hallway. d. The UAP stands by the patient's bed for 30 minutes talking with the patient.

D. Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.

External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Inspect the mouth and throat daily for the appearance of thrush. b. Maintain a high-residue, high-fiber diet. c. Test all stools for the presence of blood. d. Clean the perianal area carefully after every bowel movement.

D. Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.

The nurse will determine that teaching a 67-year-old man to irrigate his new colostomy has been effective if the patient a. fills the irrigating container with 1000 to 2000 mL of lukewarm tap water. b. stops the irrigation and removes the irrigating cone if cramping occurs. c. inserts the irrigation tubing 4 to 6 inches into the stoma. d. hangs the irrigating container 18 inches above the stoma.

D. The irrigating container should be hung 18 to 24 inches above the stoma. If cramping occurs, the irrigation should be temporarily stopped and the cone left in place. Five hundred to 1000 mL of water should be used for irrigation. An irrigation cone, rather than tubing, should be inserted into the stoma; 4 to 6 inches would be too far for safe insertion.

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate? a. Add extra spice to enhance the flavor of foods that are served. b. Add strained baby meats to foods such as casseroles. c. Teach the patient about foods that are high in nutrition. d. Avoid giving the patient foods that are strongly disliked.

D. The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. The patient's poor intake is not caused by a lack of information about nutrition.