Lippincott questions on leukemia, skin and lung cancer

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

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

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

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

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

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

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

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

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

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

A client receiving chemotherapy for cancer has an elevated serum creatinine level. The nurse should do next: A. Cancel the next scheduled chemotherapy B. Administer the scheduled dose of chemotherapy C. Notify the HCP D. Obtain a urine specimen

C Nephrotoxicity caused by chemotherapy is assessed by monitoring serum creatinine. Creatinine is the most sensitive indicator of proper kidney function. In this case, the client is experiencing decreased kidney function, most likely due to the chemotherapy. The nurse consults the HCP for guidance.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When preparing to administer a chemotherapeutic agent to a client, the nurse should: A. Recap all needles used to prepare agents B. Dispose of chemotherapy wastes in the client's bedside trash C. Use gloves and disposable long-sleeved gowns when handling agents D. Administer only prepackaged agents from the manufacturer

C Chemotherapeutic agents are very toxic; therefore, precautions are taken such as the use of gloves and long-sleeved gowns when handling agents to prevent incidental contact with skin

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A The most common toxicities from NSAIDs are gastrointestinal disorders.

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

B An individualized exercise program will increase stamina and endurance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

B Stomatitis is an inflammation of the mucous membranes of the mouth resulting from chemotherapy. Using a soft-bristled toothbrush prevents further bleeding and irritation to the already irritated gums and mucous membranes

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

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

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

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

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

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

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

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

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

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