Hematological & Oncology

The nurse is caring for a 25-year-old client who will undergo bilateral orchiectomy for testicular cancer. Considering the nature of the illness, the nurse should make it a priority to explore which potential psychological concern with this client? 1. Postoperative pain 2. Postoperative swelling 3. Loss of reproductive ability 4. Length of recuperative period

Loss of reproductive ability

The clinic nurse, performing a skin assessment, is concerned about which finding? 1. Dimpling of the skin 2. The presence of genital warts 3. A mole with round, smooth borders 4. Client report that a mole has changed to blue

Client report that a mole has changed to blue Rationale: Shades of blue in a mole are considered ominous for malignant melanoma. Dimpling of the skin in the breast area may be associated with breast cancer. Genital warts may be associated with cancer of the cervix. A mole with round, smooth borders would indicate a normal finding.

The nurse has completed discharge teaching with a client who has had surgery for lung cancer. The nurse determines that the client needs additional teaching about the elements of home management if the client verbalizes the need to follow which instruction? 1. Avoid exposure to crowds. 2. Deal with any increases in pain independently. 3. Sit up and lean forward to breathe more easily. 4. Call the primary health care provider if shortness of breath occurs.

Deal with any increases in pain independently. Rationale: The client who just had surgery for lung cancer should not be expected to deal with increases in pain independently. Health teaching includes avoiding exposure to crowds or persons with respiratory infections and reporting signs and symptoms of respiratory infection or increases in pain. The client should also use positions that facilitate respiration, such as sitting up and leaning forward.

A client has developed oral mucositis as a result of radiation to the head and neck. Which measure should the nurse teach the client to incorporate in a daily home care routine to help manage this condition? 1. A glass of wine per day will introduce useful bacterial to the oral cavity. 2. High-protein foods such as peanut butter should be incorporated in the diet. 3. Clean teeth and rinse mouth with a weak saline and water solution before and after each meal. 4. Oral hygiene, including brushing and flossing, should be performed in the morning and evening.

Clean teeth and rinse mouth with a weak saline and water solution before and after each meal.

The nurse is assessing a client with a diagnosis of polycythemia vera. Which clinical manifestation should the nurse expect to note in this client? 1. Pallor 2. Hypertension 3. A low hematocrit level 4. Pale mucous membranes

Hypertension

A community health nurse is providing a teaching session regarding the risks of breast cancer. The nurse determines that there is a need for further teaching if an attendee states that what is an associated risk factor for this type of cancer? 1. History of late menopause 2. History of cancer in 1 breast 3. Menstrual history of late menarche 4. Family history of any first-degree relative with breast cancer

Menstrual history of late menarche Rationale: Risk factors associated with breast cancer include a menstrual history of early, not late, menarche and a late menopause. Other risk factors include a history or a family history of breast cancer, including any first-degree relative (a mother or sister) with breast cancer.

A client with the diagnosis of leukemia is receiving chemotherapy. When the registered nurse (RN) notes that the white blood cell (WBC) count is 4000 mm3 (4 × 109/L), the new nurse caring for the client is informed about the results. Which intervention identified by the new nurse indicates a need for further teaching? 1. Restricting visitors with colds or respiratory infections 2. Removing all live plants, flowers, and stuffed animals in the client's room 3. Placing the client on a low-bacteria diet that excludes raw foods and vegetables 4. Padding the side rails and removing all hazardous and sharp objects from the room

Padding the side rails and removing all hazardous and sharp objects from the room Rationale: Padding the side rails and removing all hazardous and sharp objects from the environment would be instituted if the client is at risk for bleeding. This client is at risk for infection. When the WBC count is less than 5000 mm3 (5 × 109/L), visitors should be screened for the presence of infection, and any visitors or staff with colds or respiratory infections should not be allowed in the client's room. All live plants, flowers, and stuffed animals are removed from the client's room. The client is placed on a low-bacteria diet that excludes raw fruits and vegetables.

To ensure that the client diagnosed with cancer has adequate and safe pain control, which plan should the nurse implement? 1. Rely primarily on prescription and over-the-counter medications to relieve pain. 2. Keep a baseline level of pain so that the client does not become sedated or addicted. 3. Try multiple medication modalities for pain relief to get the maximum pain relief effect. 4. Start with low doses of medication and gradually increase to a safe dose that relieves pain.

Start with low doses of medication and gradually increase to a safe dose that relieves pain.

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 would be therapeutic? 1. "Would you like to talk?" 2. "You are looking good today." 3. "How do you feel about your body now?" 4. "Will your family help you deal with this?"

"How do you feel about your body now?"

The nurse is performing discharge teaching with a client diagnosed with multiple myeloma. Which activity will the nurse encourage in order to prevent the risk of pathological fractures associated with the disease? 1. Use of splints on extremities 2. Daily regimen of ambulation 3. Daily vital sign measurement 4. Aerobic exercise three times weekly

2. Daily regimen of ambulation

During history taking of a client admitted with newly diagnosed Hodgkin's disease, which symptom should the nurse expect the client to report? 1. Weight gain 2. Night sweats 3. Severe lymph node pain 4. Headache with minor visual changes

2. Night sweats

The home care nurse is caring for a client with lung cancer with acute cancer pain. Which is the most appropriate way to assess the client's pain? 1. The client's pain rating 2. The nurse's impression of the client's pain 3. Verbal and nonverbal clues from the client 4. Pain relief after appropriate nursing intervention Terms

1. The client's pain rating

A nursing instructor asks a student to identify risk factors for and methods of preventing prostate cancer. Which statement by the student indicates the need for further teaching? 1. "Smoking increases the risk for this type of cancer." 2. "A high-fat diet will assist in preventing this type of cancer." 3. "A history of a sexually transmitted infection is a risk for this disease." 4. "Men more than 50 years old should be monitored with a yearly digital rectal exam."

2. "A high-fat diet will assist in preventing this type of cancer."

The nurse caring for a client who had a laryngectomy for laryngeal cancer has provided instructions to both the client and his wife regarding the use an artificial larynx. Which statement by the client's wife indicates an understanding of the use of this device? 1. "He will need to place the device into his tracheostomy." 2. "He will need to swallow air in order for the device to work." 3. "He will need to hold the device along the side of his neck to speak." 4. "He will need to speak into the device like a microphone to make it work."

3. "He will need to hold the device along the side of his neck to speak."

The nurse caring for a client after right radical mastectomy includes which intervention in the nursing plan of care for this client? 1. Takes blood pressures in the right arm only 2. Draws serum laboratory samples from the right arm only 3. Positions the client supine and flat with the right arm elevated on a pillow 4. Checks the right posterior axilla area when assessing the surgical dressing

4. Checks the right posterior axilla area when assessing the surgical dressing

A client diagnosed with Hodgkin's disease is neutropenic as a result of radiation and chemotherapy. Which nursing intervention would be most effective in decreasing the risk of infection? 1. Providing a diet high in protein 2. Monitoring electrolyte levels daily 3. Limiting visitors to immediate family only 4. Ensuring meticulous hand washing before caring for the client

4. Ensuring meticulous hand washing before caring for the client

When the clinic nurse enters the examining room, the client is crying and says, "I know I have stomach cancer, and I know there's nothing that can be done for me." Which appropriate action should the nurse take? 1. Quietly hold the client's hand. 2. Ask the client, "What makes you think that you have cancer?" 3. Inform the client that stomach cancer has a high survival rate. 4. Call the primary health care provider about the client's depression.

Ask the client, "What makes you think that you have cancer?"

The nurse is caring for a client with a diagnosis of suspected leukemia. The nurse prepares the client for which diagnostic test that would confirm this diagnosis? 1. Lumbar puncture 2. Lymphangiogram 3. Radiographic tests 4. Bone marrow aspiration biopsy

Bone marrow aspiration biopsy Rationale: Bone marrow aspiration biopsy is a strategic diagnostic tool for confirming the diagnosis of leukemia and for identifying malignant cell types. Lumbar puncture may determine the presence of blast cells in the central nervous system. A lymphangiogram may be performed to locate malignant lesions and accurately classify the disease. Radiographic tests may detect lesions and sites of infection.

A client is admitted with sickle cell disease. The nurse monitors this client for which common symptom of the disorder? 1. Pain 2. Diarrhea 3. Bradycardia 4. Blurred vision

Pain

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? 1. Female African American 2. Recorded age of 35 years 3. Occupation of computer analyzer 4. Drinks several cups of coffee every day

Drinks several cups of coffee every day

The nurse is collecting data to determine the client's risk factors related to cervical cancer. The nurse determines which information to be significant? 1. Use of a diaphragm 2. Multiple pregnancies 3. Late onset of menarche 4. Multiple sexual partners

Multiple sexual partners

he nurse is caring for a client after a modified radical mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? 1. Pain at the incisional site 2. Arm edema on the operative side 3. Bloody drainage in the Jackson-Pratt tube 4. Complaints of numbness near the operative site

2. Arm edema on the operative side

The nurse is caring for a client in sickle cell crisis. After gathering the assessment data, the nurse determines that which action is the likely cause of the crisis? 1. A change in fluid intake 2. An increased intake of vitamin C 3. Strenuous exercise resulting in dehydration 4. Minimal rest periods over the last several days

3. Strenuous exercise resulting in dehydration

The nurse caring for a client diagnosed with an inoperable lung tumor creates a plan of care addressing complications related to the disorder. The nurse includes in the plan to monitor for the early signs/symptoms of vena cava syndrome. Which is an early sign/symptom of this oncological emergency? 1. Hand and arm edema 2. Signs of disorientation 3. Edema of the face and eyes 4. Bluish skin discoloration around the mouth

3. Edema of the face and eyes

The nurse is caring for a client who has just had a mastectomy. Which exercise should the nurse assist the client in doing during the first 24 hours after surgery? 1. Hand wall climbing 2. Pendulum arm swings 3. Elbow flexion and extension 4. Shoulder abduction and external rotation

3. Elbow flexion and extension

A client with a diagnosis of cancer of the bowel is receiving chemotherapy. When evaluating the laboratory findings, the nurse notes that the client's platelet count is 19,000 mm3 (19 × 109/L). Which problem would be of concern for this client, based on this laboratory result? 1. Infection 2. Poor nutrition 3. Potential for hemorrhage 4. Difficulty coping with diagnosis

3. Potential for hemorrhage

The nurse caring for a client with aplastic anemia is monitoring for signs and symptoms of poor oxygenation. Which observations are indicative of poor oxygenation? 1. Weakness and pallor 2. Hyperexcitability and irritability 3. Hypotension and hyperalertness 4. Peripheral edema and bradycardia

1. weakness and pallor

A client is admitted to the hospital in sickle cell crisis. For which clinical indicator should the nurse monitor the client? 1. Pain 2. Diarrhea 3. Bradycardia 4. Blurred vision

1. pain

A client calls the clinic and tells the nurse that she found an area that looks like the peel of an orange when performing a breast self-examination (BSE). She has noted no other changes. What is the appropriate nursing intervention to best address the client's concerns? 1. Reassure the client that there is nothing to worry about. 2. Arrange for the client to be seen at the clinic as soon as possible. 3. Ask the client to take her temperature and call back if she has a fever. 4. Encourage her to point the area out to the primary health care provider at her next regularly scheduled appointment.

2. Arrange for the client to be seen at the clinic as soon as possible.

A client diagnosed with polycythemia vera asks the nurse about the disorder. Which information should the nurse provide to correctly respond to the client? 1. Occurs as a result of a hereditary factor 2. Is classified as a myeloproliferative disorder 3. Occurs as a result of a lack of the intrinsic factor 4. Is an anemia that occurs as the result of poor iron intake

2. Is classified as a myeloproliferative disorder

Which tests should the nurse expect to be prescribed in diagnosing pernicious anemia? Select all that apply. 1. Myoglobin 2. Schilling test 3. Hemoglobin A1C 4. Reticulocyte count 5. A complete blood count (CBC)

2. Schilling test 4. Reticulocyte count 5. A complete blood count (CBC)

The nurse notices that a client has a pigmented mole and determines through further assessment that the mole has recently undergone color changes and become larger. The nurse should take which action? 1. Tell the client to keep a small bandage over the site. 2. Advise the client to use skin products with sunscreen. 3. Report the information to the client's primary health care provider. 4. Instruct the client to buy an over-the-counter wart removal product.

3. Report the information to the client's primary health care provider.

If both parents of a child are sickle cell trait carriers, how likely (percentage) is it that a child produced by the couple will have the disease? Fill in the blank.

25% Rationale: To have sickle cell disease, both parents would have to contribute the gene, and so the likelihood is 1 in 4, which is a 25% likelihood.

The nurse is caring for a client diagnosed with colorectal cancer who underwent resection of the tumor with creation of a colostomy. The nurse assesses the stoma postoperatively and expects to note which finding? 1. A pale stoma 2. A pink, dry stoma 3. A red, moist stoma 4. A dark, dusky stoma

3. A red, moist stoma

The nurse preparing an educational outline regarding skin care for a client about to experience radiation therapy should include which interventions? Select all that apply. 1. Apply sunscreen to the irradiated area if going out in the sun. 2. Remove the ink markings with mild soap and water after the initial radiation session is over. 3. Wash the radiation site with a mild soap and water daily unless otherwise directed by the radiologist. 4. Avoid the use of lotions or ointments on the affected skin areas unless prescribed by the radiologist. 5. Avoid direct sunlight exposure to the affected skin areas during the treatment and for 12 months after treatment.

3. Wash the radiation site with a mild soap and water daily unless otherwise directed by the radiologist. 4. Avoid the use of lotions or ointments on the affected skin areas unless prescribed by the radiologist. 5. Avoid direct sunlight exposure to the affected skin areas during the treatment and for 12 months after treatment.

The nurse is caring for a client who was admitted with a possible diagnosis of leukemia. The nurse knows that what test is definitive to the diagnose of leukemia? 1. Chromosome analysis 2. Whole-blood clotting time 3. Elevated white blood cell count 4. Bone marrow aspiration and biopsy

4. Bone marrow aspiration and biopsy

The nurse is preparing a client for upcoming radiation therapy. Which action should the nurse teach the client to avoid as part of skin care to the radiation site? 1. Using mild soap 2. Patting the skin dry 3. Wearing loose clothing 4. Removing skin markings

4. Removing skin markings

A client is receiving external radiation to the neck for cancer of the larynx. What should the nurse tell the client is a most likely side effect to be expected? 1. Diarrhea 2. Dyspnea 3. Headache 4. Sore throat

4. Sore throat

A client is being admitted to the hospital after receiving a radiation implant after being diagnosed with cervical cancer. Which priority action should the nurse implement in the care of this client? 1. Encourage the family to visit. 2. Admit the client to a private room. 3. Place the client on protective isolation. 4. Encourage the client to take frequent rest periods.

Admit the client to a private room. Rationale: The client who has a radiation implant is placed in a private room and has limited visitors. This reduces the exposure of others to the radiation. Protective isolation is unnecessary; rather, individuals other than the client need to be protected. Frequent rest periods are a helpful general intervention but are not a priority for the client in this situation.

A client receiving chemotherapy has a platelet count of 15,000 mm3 (15 × 109/L). Based on this laboratory result, which form of precautions should the nurse implement? 1. Contact 2. Bleeding 3. Respiratory 4. Neutropenic

Bleeding Rationale: When the platelet count is less than 20,000 mm3 (20 × 109/L), the client is at risk for bleeding, and the nurse should institute bleeding precautions. Contact precautions are initiated in a client who has drainage from wounds that may be infectious. Respiratory precautions are instituted for a client with a respiratory infection that is transmitted by the airborne route. Neutropenic precautions would be instituted for a client with a low neutrophil count.

The nurse is caring for a client diagnosed with gastric cancer. The nurse knows that what risk factors can lead to gastric cancer? Select all that apply. 1. Hyperchlorhydria 2. Pernicious anemia 3. Barrett's esophagus 4. Chronic atrophic gastritis 5. Alkaline reflux gastropathy 6. Infection with Helicobacter pylori

Pernicious anemia 3. Barrett's esophagus 4. Chronic atrophic gastritis 6. Infection with Helicobacter pylori

The nurse is performing a diet history on an older client who lives alone. The nurse notes that the client's typical 24-hour food intake consists of eggs and sausage for breakfast, a fast-food lunch of hamburger and French fries, take-out fried chicken for dinner, and ice cream in the evening. To decrease the risk of developing cancer, what should the nurse tell the client? 1. "You should not eat eggs." 2. "You should eat only turkey sausage." 3. "A high-fat diet increases the risk for colon cancer." 4. "Drinking a lot of alcohol increases the risk of liver cancer."

"A high-fat diet increases the risk for colon cancer." Rationale: A high-fat diet increases the risk of breast, prostate, and colon cancer. Although eggs and sausage are high in fat, they are not the only high-fat foods addressed in the question. Hamburger, fries, fried chicken, and ice cream are also high in fat. Drinking large quantities of alcohol does increase the risk of liver cancer, but drinking alcohol is not mentioned in the question.

The nurse is assessing 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? 1. "Are you tiring easily?" 2. "Do you have any weakness?" 3. "Have you gained any weight recently?" 4. "Have you noticed any swollen lymph nodes?"

"Have you noticed any swollen lymph nodes?" Rationale: Hodgkin's disease is a chronic, progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Fatigue and weakness may occur but are not significantly related to the disease. Weight loss is most likely to be noted.

The nurse is providing instructions to a client after a mastectomy who will be discharged to home with the axillary drain in place. Which statement by the client indicates a need for further instructions? 1. "I can use lotion on the skin once the incision heals." 2. "I may feel some incisional discomfort until healing occurs." 3. "I should keep my arm elevated when I sit or lie down to prevent swelling." 4. "I must begin full range-of-motion (ROM) exercises to my upper arm once I get home."

"I must begin full range-of-motion (ROM) exercises to my upper arm once I get home.

The nurse is caring for a client after a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer. The nurse provides discharge instructions to the client's wife regarding stoma care. Which statement by the client's wife would indicate a need for further teaching? 1. "He needs to keep powder away from the stoma site." 2. "I need to use an air conditioner because of the humidity in our house." 3. "He needs to avoid showers and avoid water from getting into his stoma." 4. "I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking."

"I need to use an air conditioner because of the humidity in our house."

The home care nurse visits a client diagnosed with breast cancer who has been receiving chemotherapy. The client reports mouth soreness, and upon inspection of the client's mouth the nurse notes that the client is experiencing stomatitis. The nurse provides instructions to the client regarding treatment measures for stomatitis and determines that the client understands these measures if the client makes which statement? 1. "I will use a weak sodium bicarbonate mouth rinse." 2. "Lemon and glycerin swabs will ease the discomfort." 3. "Mouthwash containing an alcohol base will kill the bacteria." 4. "I need to rinse my mouth with a mixture of hydrogen peroxide at ¾ strength and tap water."

"I will use a weak sodium bicarbonate mouth rinse." Rationale: An acidic environment in the mouth is favorable for bacterial growth, especially in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth at least before every meal and at bedtime with a weak sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of severe plaque, it should be a very weak solution because it dries the mucous membranes.

The nurse is teaching a client diagnosed with cervical cancer about high-dose brachytherapy done as an outpatient procedure. What discharge instructions should the nurse give to the client? Select all that apply. 1. "Make sure to report constipation." 2. "Stay away from your family or the public even between treatments." 3. "Report heavy vaginal bleeding to your primary health care provider." 4. "Tell your primary health care provider if you have any abdominal pain." 5. "Notify the primary health care provider if you have a fever over 100° F (38° C)."

. "Report heavy vaginal bleeding to your primary health care provider." 4. "Tell your primary health care provider if you have any abdominal pain." 5. "Notify the primary health care provider if you have a fever over 100° F (38° C)."

During the nursing assessment, the client states, "My surgeon just told me that my cancer has spread, and I have less than 6 months to live." Which nursing response would be the most therapeutic? 1. "I am sorry. Would you like to discuss this with me some more?" 2. "I am sorry. There are no easy answers in times like this, are there?" 3. "I hope you'll focus on the fact that your doctor says you have 6 months to live and that you'll think of how you'd like to live." 4. "I know it seems desperate, but there have been a lot of breakthroughs. Something might come along in a month or so to change your status drastically."

1. "I am sorry. Would you like to discuss this with me some more?"

The nurse is assessing a client with a diagnosis of multiple myeloma for dehydration related to hypercalcemia. The nurse notifies the primary health care provider of which signs/symptoms of hypercalcemia? Select all that apply. 1. Fatigue 2. Nausea 3. Diarrhea 4. Anorexia 5. Scant urine output

1. Fatigue 2. Nausea 4. Anorexia Rationale: Clients with multiple myeloma are at risk for hypercalcemia. Fatigue, nausea, anorexia, vomiting, polyuria, weakness, and constipation, along with dehydration, are signs/symptoms of moderate hypercalcemia. The nurse needs to monitor for these signs/symptoms and report them immediately to the primary health care provider. Activity is encouraged. A fluid intake of 3000 mL daily is required to dilute the calcium overload and to prevent protein from precipitating in the renal tubules. A high-calorie diet is encouraged, because a low-fiber diet can lead to constipation.

When a client is scheduled for cryosurgery for the treatment of cervical cancer, the nurse provides instructions regarding the procedure. Which statement by the client indicates a need for additional teaching? 1. "I could feel faint during cryosurgery." 2. "I need general anesthesia for this procedure." 3. "I may experience some cramping during the procedure." 4. "I may have watery cervical discharge after the procedure."

2. "I need general anesthesia for this procedure."

A client diagnosed with cancer of the bladder is fearful of the potential outcomes of an upcoming cystectomy and urinary diversion. Which statement made to the nurse indicates the client's fear? 1. "I wish I'd never gone to the doctor at all." 2. "I'm so afraid that I won't live through all this." 3. "I'll never feel like myself if I can't go to the bathroom normally." 4. "What if I have no help at home after going through this awful surgery?"

2. "I'm so afraid that I won't live through all this."

Which nursing intervention should the nurse include in the plan of care for a client scheduled for an abdominal perineal resection for a bowel tumor? 1. Clamp the Penrose drain. 2. Change the wound dressing as needed. 3. Remove and replace the perineal packing 12 hours postoperatively. 4. Notify the surgeon if serosanguineous drainage from the wound is noted.

2. Change the wound dressing as needed.

The nurse is reviewing the record of a client diagnosed with cervical cancer. Which risk factor associated with this type of cancer should the nurse expect to note in the client's record? 1. Single female, no children 2. History of human papilloma virus 3. Intercourse with circumcised males 4. Intercourse with a single sex partner

2. History of human papilloma virus

Which clinical manifestations seen in a client with sickle cell disease would indicate a complication of a vaso-occlusive crisis? Select all that apply. 1. Fatigue 2. Priapism 3. Dactylitis 4. Jaundice 5. Acute chest syndrome

2. Priapism 3. Dactylitis 5. Acute chest syndrome

The staging of a client's cancerous tumor is documented as T3, N2, M1. How should the nurse analyze the staging of this cancer? 1. The tumor is in situ. 2. The tumor is 3 cm in size. 3. Distant metastasis was found. 4. Nodal involvement cannot be assessed.

3. Distant metastasis was found.

The nurse is caring for a client diagnosed with osteosarcoma. The prescribed alkaline phosphatase test yields an increased value. How should the nurse plan to respond? 1. Administer antibiotic therapy. 2. Carefully assess neurological status. 3. Gently perform routines that cause movement. 4. Call the primary health care provider immediately.

3. Gently perform routines that cause movement.

The nurse is planning a health fair at a local college, and information about testicular cancer will be provided. Which information should the nurse provide about the early signs/symptoms of testicular cancer? 1. A palpable, painful lump is present. 2. It is accompanied by sharp pain and scrotal heaviness. 3. A sensation of heaviness and an enlarged painful scrotum are noted. 4. A palpable, painless lump with possible scrotal enlargement is found.

4. A palpable, painless lump with possible scrotal enlargement is found.

A client diagnosed with prostate cancer with suspected bone metastasis is scheduled for a bone scan. The nurse determines that the client understands the elements of follow-up care after the scan if the client states to take which action? 1. Report any feelings of nausea or flushing. 2. Eat only small meals for the remainder of the day. 3. Ambulate at least three times before the end of the day. 4. Drink plenty of water for a day or two after the procedure.

4. Drink plenty of water for a day or two after the procedure.

A client is admitted to the hospital with a diagnosis of infiltrating ductal carcinoma of the breast. Which expected manifestation should the nurse assess the client for? 1. Bilateral palpable masses 2. Pain in the breast and edema 3. A fixed, irregularly shaped mass 4. A round-shaped mass that is moveable

A fixed, irregularly shaped mass Rationale: Infiltrating ductal carcinoma of the breast usually presents as a fixed, irregularly shaped mass. The mass is usually single and unilateral and is painless, nontender, and hard to the touch.

A client diagnosed with multiple myeloma is receiving intravenous hydration at 100 mL per hour. Which finding indicates to the nurse that the client is experiencing a positive response to the treatment plan? 1. Weight increase of 1 kilogram 2. Respirations of 18 breaths per minute 3. Creatinine of 1.0 mg/dL (88 mcmol/L) 4. White blood cell count of 6000 mm3 (6 × 109/L)

Creatinine of 1.0 mg/dL (88 mcmol/L)

The nurse reviewing the history and physical for a client being admitted to the hospital with a diagnosis of colon tumor notes that the primary health care provider has documented that the client has a right colon tumor. Which clinical manifestation should the nurse expect the client to report when obtaining subjective data from the client? 1. Diarrhea 2. Crampy gas pains 3. Flat ribbon-like stools 4. Dull abdominal pain exacerbated by walking

Dull abdominal pain exacerbated by walking Rationale: Characteristic signs/symptoms of right colon tumors include vague, dull abdominal pain exacerbated by walking, and dark red or mahogany-colored blood mixed in the stool. The other signs/symptoms are associated with left colon tumors.

A client has been diagnosed with disseminated intravascular coagulation (DIC). Which laboratory results are expected with this diagnosis? Select all that apply. 1. Elevated D-dimer 2. Decreased hemoglobin 3. Elevated platelet count 4. Increased fibrinogen level 5. Increased prothrombin time 6. Increased activated partial thromboplastin time

Elevated D-dimer 2. Decreased hemoglobin Increased prothrombin time 6. Increased activated partial thromboplastin time

A client has undergone vaginal hysterectomy for the treatment of uterine cancer. In the postoperative plan of care, the nurse should avoid which activity? 1. Using pneumatic compression boots 2. Assisting with range-of-motion leg exercises 3. Removing antiembolism stockings twice daily 4. Elevating the knees and placing extra pillows under the knees

Elevating the knees and placing extra pillows under the knees Rationale: The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as with any other major surgery. For this reason, the nurse implements measures that will prevent this complication. Pneumatic compression boots, range-of-motion exercises, and antiembolism stockings (if prescribed) are all helpful. The nurse should avoid using the knee gatch on the bed or elevating the knees with the use of pillows, which inhibits venous return, therefore placing the client more at risk for deep vein thrombosis or thrombophlebitis.

Which complementary and alternative therapies would be beneficial to induce relaxation for a client diagnosed with advanced lung cancer? Select all that apply. 1. Biofeedback 2. Acupuncture 3. Herbal therapy 4. Passive relaxation 5. Creative visualization 6. Active progressive relaxation

Passive relaxation 5. Creative visualization

A client received radiation therapy followed by chemotherapy to treat a lung tumor. The nurse should monitor for which specific cardiovascular complication associated with these treatments? 1. Pericarditis 2. Hypertension 3. Atherosclerosis 4. Coronary artery disease

Pericarditis Rationale: The client receiving radiation and chemotherapy can experience a variety of complications associated with the cardiovascular system, such as inflammation secondary to radiation (pericarditis); ECG changes; and rapidly progressing heart failure. Hypertension, atherosclerosis, and coronary artery disease are not specific cardiovascular complications of these treatments.

The nurse creating a plan of care for a client after a radical mastectomy includes measures that will assist in preventing lymphedema of the affected arm. What intervention should the nurse include to prevent this complication? 1. Place the affected arm on a pillow. 2. Place a cool compress on the affected arm. 3. Place the affected arm in a dependent position. 4. Instruct the client to avoid simple arm exercises in the affected arm.

Place the affected arm on a pillow.

A client who is receiving chemotherapy tells the nurse that food has an unpleasant taste. Which intervention by the nurse is appropriate? 1. Provide oral hygiene care. 2. Keep the client fasting (NPO). 3. Administer an antiemetic as prescribed. 4. Obtain a prescription for parenteral nutrition (PN).

Provide oral hygiene care. Rationale: Cancer treatments may cause distortion of taste. Frequent oral hygiene is one intervention that aids in preserving taste function. Keeping a client NPO increases nutritional risks. Antiemetics are used when nausea and vomiting are a problem. Parenteral nutrition (PN) is used when oral intake is not possible.

he nurse is caring for a client diagnosed with metastatic lung cancer. The client was medicated 2 hours ago and now reports a new and sudden sharp pain in the back. What should the nurse interpret is the cause of this assessment finding? 1. Further metastasis 2. A low pain threshold 3. Spinal cord compression 4. The need for an increase in pain medication

Spinal cord compression Rationale: Spinal cord compression should be suspected in a client with metastatic disease, particularly when a new and sudden onset of back pain occurs. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression is an oncological emergency, and the primary health care provider should be notified. No data in the question support a low pain threshold. Further metastasis and the need for more pain medication may be accurate but are not the most appropriate interpretation of the new and sudden pain that developed.

A female client who has been receiving radiation therapy for a diagnosis of bowel cancer tells the nurse that it feels as if she is passing flatus through the vagina. The nurse interprets that the client may be experiencing which disorder? 1. Rupture of the bowel 2. Altered perineal sensation 3. The development of a rectovaginal fistula 4. The development of a vesicovaginal fistula

The development of a rectovaginal fistula

The nurse is developing a plan of care for a young adult client newly diagnosed with testicular cancer. Which is most likely is a priority for this client? 1. The possibility of sexual dysfunction 2. The increased risk for infection because of a surgical incision 3. Correct skin hygiene that will minimize effects of radiation therapy 4. Various ongoing treatment options that he and his support system can discuss

The possibility of sexual dysfunction Rationale: Even if testicular cancer is detected in an early stage, the client newly diagnosed with testicular cancer might be afraid that he will be sexually handicapped, and feelings of sexual inadequacy may occur. The appropriate priority intervention would be discussing the possibility of sexual dysfunction. Although the other interventions may be appropriate at some point, there are no data in the question to indicate that these are current concerns.

Which signs/symptoms would the nurse expect to note in a client diagnosed with pernicious anemia? Select all that apply. 1. Weakness 2. Constipation 3. Shortness of breath 4. Dusky lips and gums 5. Smooth, sore, red tongue

Weakness 5. Smooth, sore, red tongue Rationale: Classic clinical indicators of pernicious anemia include weakness; mild diarrhea; and a smooth, sore, red tongue. The client may also have neurological findings, such as paresthesias, confusion, and difficulty with balance. Constipation is not a common finding with pernicious anemia. Pernicious anemia does not affect tissue oxygenation, so the mucous membranes do not become dusky, and the client does not exhibit shortness of breath.

The nurse instructs a postmenopausal client about performing breast self-examination (BSE). Which client statement indicates a need for further instruction? 1. "I don't need to do that at my age." 2. "I examine my breasts in the shower." 3. "I lie on my back to examine my breasts." 4. "I do BSE on the first day of every month."

1. "I don't need to do that at my age."

The nurse caring for a client with a sealed radioactive implant determines that the client understands the best practice safety measures required when the client makes which statements? Select all that apply. 1. "I've had to remind my wife to close the door to my room when she visits." 2. "I told my pregnant daughter to be sure to stay at least 6 feet from my bed." 3. "It's hard not to see my little grandchildren, but their visits will have to wait." 4. "After the implants are removed, I'll still be emitting radiation for a few days." 5. "If the implant should become dislodged, I know to call the nurse immediately."

1. "I've had to remind my wife to close the door to my room when she visits." 3. "It's hard not to see my little grandchildren, but their visits will have to wait." 5. "If the implant should become dislodged, I know to call the nurse immediately."

The community health nurse is providing an educational session to a group of community members regarding the risk factors associated with colorectal cancer. The nurse determines that there is a need for further teaching if a client states that what is a risk factor for this type of cancer? 1. A diet high in fiber 2. A history of rectal polyps 3. Family history of colon cancer 4. A diet high in fats and carbohydrates

1. A diet high in fiber

The nursing instructor asks a student to identify the risk factors and methods of prevention related to prostate cancer. Which statement by the student indicates a need for further teaching? 1. A high-fat diet will assist in preventing this type of cancer. 2. African American men have a high incidence of this type of cancer. 3. Men aged 50 and older should be monitored with a yearly digital rectal examination. 4. There is a risk factor associated with regular handling of cadmium batteries.

1. A high-fat diet will assist in preventing this type of cancer.

A client is preparing for discharge 10 days after a radical vulvectomy. The nurse determines that the client has the best understanding of the measures to prevent complications when the client expresses plans to engage in which activity after discharge? 1. Walk 2. Housework 3. Drive a car 4. Spend most of the day sitting

1. Walk

The nurse assessing the stoma of a client after an ureterostomy notes that the stoma appears pale. Which interpretation should the nurse make on the basis of this assessment finding? 1. A fluid volume deficit 2. A normal appearance of the stoma 3. A total loss of vascular supply to the stoma 4. An inadequate amount of vascular supply to the stoma

An inadequate amount of vascular supply to the stoma

A client diagnosed with cancer develops thrombocytopenia secondary to adverse effects of chemotherapy. Based on this disorder, the nurse should primarily monitor the results of which laboratory study closely? 1. Platelet count 2. White blood cell (WBC) count 3. Antinuclear antibody titer (ANA) 4. Erythrocyte sedimentation rate (ESR)

Platelet count Rationale: The client who has thrombocytopenia has an insufficient number of platelets. This puts the client at risk for bleeding. Other related studies that should be monitored include hemoglobin, hematocrit, and coagulation studies. The WBC count indicates infection, whereas the ESR is a nonspecific test indicating inflammation. The ANA titer is a test of immune function and can indicate the presence of certain autoimmune disorders.

The nurse is teaching a client who is scheduled for radiation therapy about the therapy. Which statement by the client indicates a need for further teaching? 1. "I'm certain that this will do the trick." 2. "I will be radioactive after the therapy." 3. "This is just one of several options I have for treatment." 4. "This treatment is great, because it is invisible and very effective."

"I will be radioactive after the therapy." Rationale: A need for further teaching occurs when the client states that she or he will be radioactive after the therapy. Education by the nurse can eliminate the fear and misconceptions of radiation therapy and support the client and family. Some of the most common fears and misconceptions include fear of being burned, fear of being radioactive, the radioactive treatment, treatment failure, and the adverse effects. The remaining statements are correct although additional information may need to be provided to the client.

The home care nurse visits a client diagnosed with cancer who recently received a course of chemotherapy. The client has developed stomatitis, and the nurse provides instructions to the client about the care of the mouth. Which client statement should lead the nurse to determine that the client needs further instructions? 1. "I will eat foods without spices." 2. "I will maintain a diet of soft foods." 3. "I will drink juices that are not citrus." 4. "I will drink foods and liquids that are hot."

"I will drink foods and liquids that are hot." Rationale: Stomatitis is a term that is used to describe the inflammation and ulceration of the mucosal lining of the mouth. Dietary modifications for this condition include avoiding extremely hot foods, spices, and citrus fruits and juices. The client should be instructed to eat soft foods and to take nutritional supplements as prescribed. Food and fluid should be lukewarm or cold.

A client diagnosed with gastric cancer is being sent home from the hospital and will be receiving total parenteral nutrition (TPN). As part of the discharge teaching, the client and family members have been taught the aspects of home care for TPN. What comment by the client indicates a need for further teaching? 1. "This therapy gives me needed calories." 2. "I have to monitor my weight every day." 3. "I need to document my fluid intake and output while I'm on this nutrition." 4. "My doctor will check my calcium level because it can drop too low while I am on this nutrition."

"My doctor will check my calcium level because it can drop too low while I am on this nutrition." Rationale: There is a need for further teaching when the client receiving TPN says that her or his calcium level is checked for hypocalcemia. Calcium imbalances, particularly hypercalcemia, are associated with TPN. The primary health care provider usually requests frequent determinations of serum metabolic and electrolyte levels to detect any imbalances. TPN provides needed calories and spares body proteins from catabolism for energy requirements. Monitoring daily weights and documenting accurate intake and output is necessary while the client is receiving parenteral nutrition. The malnourished client discharged to home on enteral or parenteral nutrition support needs the specialized services of a home nutrition therapy team, consisting of a primary health care provider, nurse, dietitian, pharmacist, and case manager or social worker. Several commercial companies supply these services to clients at home in addition to the feeding supplies and formulas and health teaching.

What information should the nurse provide to the client with a low neutrophil count to minimize the risk of infection? Select all that apply. 1. Get plenty of sleep and rest. 2. Take all medications as prescribed. 3. Eat plenty of fresh fruits, salads, and vegetables. 4. Wash your hands frequently with antibacterial soap. 5. Meats must be cooked to medium rare, rather than rare. 6. Indoor plants should be kept to the nonblooming varieties.

1. Get plenty of sleep and rest. 2. Take all medications as prescribed. 4. Wash your hands frequently with antibacterial soap.

What should the nurse preparing to administer intravenous (IV) chemotherapy include in the plan of care? Select all that apply. 1. Monitoring the IV site for edema 2. Assessing the client for IV site pain frequently during the infusion 3. Applying iced compresses to the affected site if extravasation occurs 4. Wearing all of the appropriate personal protective equipment (PPE) 5. Having access to the appropriate medication antidote if extravasation occurs

1. Monitoring the IV site for edema 2. Assessing the client for IV site pain frequently during the infusion 4. Wearing all of the appropriate personal protective equipment (PPE) 5. Having access to the appropriate medication antidote if extravasation occurs

A client has had a left mastectomy with axillary lymph node dissection. Which home care instructions should the nurse provide to the client? Select all that apply. 1. Use a thimble when sewing. 2. Carry a handbag over the left shoulder. 3. Wear rubber gloves when washing dishes. 4. Use a straight razor to shave under the arms. 5. Carry grocery bags in the left arm below shoulder level. 6. Ask health care providers to take blood pressure measurements on the right arm.

1. Use a thimble when sewing. 3. Wear rubber gloves when washing dishes. 6. Ask health care providers to take blood pressure measurements on the right arm.

he nurse's teaching plan for a client with a family history of breast cancer should include which important item? 1. Assessing for grief reactions 2. Implementing measures to prevent cancer 3. Teaching the importance of weight-bearing exercises 4. Teaching breast self-examination (BSE) technique to be done every month

4. Teaching breast self-examination (BSE) technique to be done every month

client receiving chemotherapy has an infiltrated intravenous line and extravasation at the site. Which actions should the nurse prepare to take in the management of this situation? Select all that apply. 1. Leave the needle in place. 2. Aspirate any residual medication. 3. Apply direct manual pressure to the site. 4. Stop the administration of the medication. 5. Administer an available antidote as prescribed.

Leave the needle in place. 2. Aspirate any residual medication. 4. Stop the administration of the medication. 5. Administer an available antidote as prescribed. Rationale: Extravasation is the leakage of medication into surrounding skin and subcutaneous tissue. Agency procedures are followed if the client experiences extravasation. However, general recommendations for managing extravasation of a chemotherapeutic agent include stopping the infusion, leaving the needle in place, attempting to aspirate any residual medication from the site (the needle would be removed after treatment of the event), administering an antidote if available, and assessing the site for complications. Direct pressure is not applied to the site because it could further injure tissues exposed to the chemotherapeutic agent.

The nurse reviews the result of the white blood cell count of a client diagnosed with Hodgkin's disease who has received chemotherapy. The result of the test is reported as 2000 mm3 (2 × 109/L). After analyzing the result, what conclusion concerning the client's white blood cell count should the nurse make? 1. It is normal for this client. 2. It is insignificant and unrelated to Hodgkin's disease. 3. It is lower than normal, signifying leukopenia caused by chemotherapy. 4. It is higher than normal, signifying the spread of disease to bone marrow.

It is lower than normal, signifying leukopenia caused by chemotherapy. Rationale: The normal white blood cell count is 5000 jto 10,000 mm3 (5 to 10 × 109/L). Chemotherapy agents cause medication-induced leukopenia, and treatment focuses on this side effect. The correct conclusion is the one that describes the correct interpretation of the client's white blood cell count. A white blood cell count of 2000 mm3 (2 × 109/L) is not normal, high, or insignificant.

The nurse provides instructions to the client who received cryosurgery (cervical ablation) for a local stage 0 cervical tumor. Which instruction should the nurse give the client? 1. To avoid tub baths 2. That pain indicates a complication of the procedure 3. To call the primary health care provider if a watery discharge is noted 4. To call the primary health care provider discharge remains odorous after 1 week

1. To avoid tub baths Rationale: Healing after cryosurgery takes about 10 weeks. Tub baths and sitz baths need to be avoided. Showers or sponge baths should be taken during this time. Mild pain may occur and continue for several days after this procedure. A clear, watery discharge is expected. For about 14 days, this is followed by discharge that contains debris, which may be odorous. If the discharge continues for more than 8 weeks, an infection is suspected.

The nurse plans care for a client diagnosed with leukemia understanding that the client is at risk for which complications? Select all that apply. 1. Anemia 2. Oral lesions 3. Neutropenia 4. Splenomegaly 5. Rhabdomyolysis 6. Thrombocytopenia

Anemia 2. Oral lesions 3. Neutropenia 4. Splenomegaly 6. Thrombocytopenia Rationale: Leukemia is a term used to describe a group of malignant disorders affecting the blood and blood-forming tissues of the bone marrow, lymph system, and spleen. Complications that occur as a result of this disease process include anemia, oral lesions, neutropenia, splenomegaly, thrombocytopenia, hepatomegaly, lymphadenopathy, bone pain, and meningeal irritation. Rhabdomyolysis is an acute and serious syndrome caused by the breakdown of skeletal muscle and is not specifically associated with leukemia.

The nurse is caring for a client who just had a bone marrow aspiration to confirm a suspected diagnosis of aplastic anemia. What are specific nursing care interventions the nurse needs to perform? Select all that apply. 1. Give a mild analgesic, like aspirin, for discomfort. 2. Place hot packs over the site to increase circulation. 3. Cover the site with a dressing after bleeding is controlled. 4. Observe the site for 24 hours for signs/symptoms of bleeding and infection. 5. Upon same day discharge, tell the client to avoid any activity that could lead to trauma to the site for 48 hours.

Cover the site with a dressing after bleeding is controlled. 4. Observe the site for 24 hours for signs/symptoms of bleeding and infection. 5. Upon same day discharge, tell the client to avoid any activity that could lead to trauma to the site for 48 hours. Rationale: The nursing priority after a bone marrow aspiration or biopsy is prevention of excessive bleeding. The site needs to be covered with a dressing after bleeding is controlled, and closely observed for 24 hours for signs of bleeding and infection. A mild analgesic (aspirin-free) may be given for discomfort, and ice and not hot packs can be placed over the site to limit bruising. If the client goes home the same day as the procedure, instruct him or her to inspect the site every 2 hours for the first 24 hours to assess for active bleeding or bruising. Advise the client to avoid any activity that might result in trauma to the site for 48 hours.

The nurse is creating a plan of care for a client being admitted to the hospital for insertion of a cervical radiation implant. What action should be included in the plan for this client after insertion of the implant? 1. Maintain bed rest. 2. Elevate the head of the bed 45 degrees. 3. Turn the client side to side every 2 hours. 4. Move the client out of bed and into a chair only.

Maintain bed rest. Rationale: The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 20 degrees for comfort. The nurse should avoid turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees, and, with the body in straight alignment, the client is logrolled. Movement in bed is restricted to prevent dislodgement of the radioactive source.

A client has had a left mastectomy with axillary lymph node dissection. The nurse determines that the client understands postoperative restrictions and arm care when the client states the intention to engage in which activity? 1. Using gloves when working in the garden 2. Using a straight razor to shave under the arms 3. Carrying a handbag and heavy objects on the left arm 4. Allowing blood pressures to be taken only on the left arm

1. Using gloves when working in the garden Rationale: The client is at risk for edema and infection as a result of lymph node dissection. The client should use a variety of techniques to avoid trauma to the affected arm. Examples include using gloves when working in the garden, an electric razor to shave under the arm, and pot holders when cooking to prevent burns. The client should also avoid activities that increase edema, such as carrying heavy objects or having blood pressures taken on the affected arm.

The nurse is preparing a chemotherapy infusion to be administered to a client with a diagnosis of Hodgkin's disease. Which precaution should the nurse take during the preparation of this intravenous (IV) infusion? Select all that apply. 1. Wear a mask. 2. Wear a gown. 3. Wear double gloves. 4. Wear double booties. 5. Wear eye protectors.

1. Wear a mask. 2. Wear a gown. 3. Wear double gloves. . Wear eye protectors.

The nurse is preparing instructions regarding skin care for a client receiving external radiation therapy to the chest area to treat a lung tumor. What information should be included in the teaching plan? 1. Use deodorants only once daily. 2. Limit sun exposure to 3 times a week. 3. Wear snug-fitting clothing to prevent irritation. 4. Avoid the use of lotions on the area being treated.

4. Avoid the use of lotions on the area being treated. Rationale: The client is instructed to avoid the use of lotions on the area being treated. Deodorant should not be used during treatment to the chest area. The client needs to be instructed to avoid exposure to the sun. The client should wear loose, not snug-fitting, clothing over the area.

A client with a suspected diagnosis of leukemia and scheduled for bone marrow aspiration asks the nurse about possible sites that could be used to perform the procedure. The nurse identifies which possible locations? Select all that apply. 1. Ribs 2. Femur 3. Scapula 4. Sternum 5. Iliac crest

4. Sternum 5. Iliac crest

A client is admitted to the hospital experiencing severe bone pain associated with multiple myeloma. The nurse anticipates that in addition to administering pain medication, which intervention will be prescribed to address the client's pain? 1. Bed rest 2. Radiation therapy 3. NPO except for sips of water with medication 4. Hydration with normal saline intravenously only

Radiation therapy A client is admitted to the hospital experiencing severe bone pain associated with multiple myeloma. The nurse anticipates that in addition to administering pain medication, which intervention will be prescribed to address the client's pain?

The nurse has taught a postmenopausal woman at risk for breast cancer how to do breast self-examination (BSE). The nurse determines that the client understands the procedure if the client makes which statement? 1. "I will palpate my breasts while standing in front of the mirror." 2. "I will do the exam 14 days after the start of my menstrual cycle." 3. "I will use the pads of my fingers and press deeply to feel lumps." 4. "I will examine my right breast with my right hand, and vice versa."

"I will use the pads of my fingers and press deeply to feel lumps." Rationale: Women who are postmenopausal are taught to do BSE on the same day of every month. Before menopause, women should do the procedure 7 days after the start of the menstrual cycle when the breasts are least tender. Each breast is examined with the opposite hand. The pads of the fingers should be used for palpation, and the client should press deeply, feeling for lumps. The client may use a circular, up-and-down, or wedge method of assessment. Consistency of use of the same method is more important than the actual method used. The client should inspect the breasts while standing in front of a mirror. The client should palpate the breasts while in the shower because soapy wet skin makes it easy to slide the pads of the fingers across breast tissue, or the client can palpate the breasts while in the supine position.

The nurse is caring for a postoperative client who had a mastectomy with axillary lymph node dissection. How should the nurse position the client to promote prevent lymphedema? 1. Side-lying on the affected side 2. Supine with the client's head resting on one pillow 3. High-Fowler's with both arms positioned on an over bed table 4. Semi-Fowler's with the affected arm elevated above the level on the heart

Semi-Fowler's with the affected arm elevated above the level on the heart Rationale: After mastectomy with axillary lymph node dissection, the nurse should position the client in a semi-Fowler's position, with the affected arm elevated above the level of the heart. This position helps to promote drainage and prevent lymphedema. The other positions are not appropriate for this client.

A client has undergone a mastectomy. The nurse determines that the client is having the most difficulty adjusting to the loss of the breast when which behavior is observed? 1. Refuses to look at the dressing 2. Requires help with sponge bathing 3. Asks that the nurse limit visitors to only family 4. Dresses in a loose nightgown the client brought from home

Refuses to look at the dressing Rationale: The client demonstrates the most difficult adjustment to the loss if she refuses to look at the dressing. This indicates that the client is not ready or willing to begin to acknowledge and cope with the surgery. Requiring help with sponge bathing is expected after major surgery, limiting visitors is also an expected behavior soon after surgery, and dressing in her own nightgown indicates that the client is retaining her self-esteem.

The home care nurse has been visiting a client diagnosed with lung cancer weekly over the past month. Over time, the nurse notes increasing dyspnea and increasing edema of the face and arms of the client. The nurse analyzes these signs/symptoms and determines that they are consistent with which condition? 1. Kidney failure 2. Distant metastasis 3. Spinal cord compression 4. Superior vena cava syndrome

Superior vena cava syndrome Rationale: The superior vena cava is the large vessel that accepts blood from the head, neck, and arms, returning it to the heart. Therefore, compression of this vessel by a tumor or by enlarged lymph nodes can cause decreased blood return from these areas, resulting in swelling and increased dyspnea. Although spinal cord compression is another oncological emergency, it does not cause these symptoms. Distant metastasis would, by definition, not be near the lungs in this case. The edema noted in kidney disease would not be confined to these specific areas of the body.