NCLEX PRACTICE QUESTIONS-ONCOLOGY UNITY 1

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates successful teaching?

"I clean my teeth gently several times per day" Reduces bacteria build up in the oral cavity-reduces infection risk Avoid alcohol based products

A 52 yr client is scheduled for a total abdominal hysterectomy for cervical cancer. When discussing the potential impact of this procedure on the client s sexuality, the nurse should respond by saying?

"Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions"? This question introduces some basic information and allows for support for the client who may be experiencing some sexuality concerns. Not all women experience sexual problems after undergoing a hysterectomy. Assuming that the client will want to schedule an appointment with her partner is inappropriate and may embarrass her. Simply asking the client whether she expects to have problems with sex is too abrupt and does not provide any information.

On the third postoperative day after a radical mastectomy, the drainage tube is removed, and the dressings are changed. The client appears shocked when she sees the operative area and exclaims, "I look horrible! Will it ever look better" Which response by the nurse would be most appropriate?

"You are shocked by the sudden change in your appearance as a result of this surgery are you not"? When a client appears shocked by her appearance after surgery, such as after having a mastectomy, the nurse should help her express her feelings and offer the supportive care that she needs at this time. Telling the client that her disfigurement will not show when she is dressed dismisses her concerns and blocks expression of her feelings. Telling the client not to worry avoids the issues. Having the client meet someone who has had breast surgery is often helpful but is better done later, when the client is convalescing and accustomed to the appearance of the operative site. The client needs support now when the dressings are removed, not later.

A client at risk for lung cancer asks the reason for having a computed tomography scan as part of the initial exam. Best response?

"useful for distinguishing small differences in tissue density and detecting nodal involvement" can distinguish small differences in tissue density/detect nodule involvment

Which nursing goal is appropriate for a client with multiple myeloma:

Achieve effective management of bone pain neoplastic plasma cells invade the bone marrow and begin to destroy bone. As a result of this skeletal destruction, pain can be significant. There is no cure for multiple myeloma, N/V are not characteristics of the disease, although the client may experience anorexia. The client should be monitored for signs of hyperglycemia resulting from bone destruction, not for hyperkalemia

What instructions should the nurse provide to a client who develops cellulitis in the right arm after a right modified radical mastectomy?

Antibiotics will need to be taken for 1-2 wks Treatment for cellulitis includes oral or intravenous antibiotics for 1 to 2 weeks, elevation of the affected extremity, and application of warm, moist packs to the site. Arm exercises help to reduce swelling, but do not treat the infection.

The nurse is working at the local family planning clinic completing family education. When devising a teaching plan, in which client group would the nurse stress the importance of an annual papanicolaou test?

Clients infected with HPV associated with genital warts not risk: recurrent candidiasis, pregnancy before age 20, oral contraceptive use

A nurse is assessing a woman who is receiving the second administration of chemotherapy for breast cancer. When obtaining this client's health history, the nurse should ask the client which question?

Have you had nausea or vomiting? Chemotherapy agents typically cause nausea and vomiting when not controlled by antiemetic drugs. Antineoplastic drugs attack rapidly growing normal cells, such as in the gastrointestinal tract. These drugs also stimulate the vomiting center in the brain. Hair loss, loss of energy, and sleep are important aspects of the health history, but are not as critical as the potential for dehydration and electrolyte imbalance caused by nausea and vomiting.

When developing a plan of care to manage a client's pain from cancer, what should the nurse plan to do?

Individualize the pain med regimen for the client

A nurse is caring for a client receiving chemo. Which assessment finding places the client at the greatest risk for an infection

Stage 3 pressure ulcer on the left heel Temp. is slightly elevated...not as relevant as the pressure ulcer (99.8)

After a lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is function correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breaths?

Water seal chamber Indicates normal function of the system as the pressure in the tubing changes with the client's respirations. Air leak meter-not chamber-detects air leaking from the pleural space. The collection chamber connects the chest tube from the client to the system. Suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest.

A client has just begun treatment with busulfan, 4 mg by mouth daily, for chronic myelogenous leukemia. The client recieves busulfan until his WBC count falls to bt 10,000 and 25,000. Then the drug is stopped. When should treatment resume?

When the WBC rises to 50,000 Busulfan treatment should resume when ""

The client who is in end stages of cancer is requesting spiritual support

call a chaplain and set up an appointment for spiritual guidance the client must be consulted before referral

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hrs. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plant to include:

chemotherapy exposure risk factors

The nurse is conducting an initial history of a client who is experiencing pain related to bone cancer. The most important info to gather in this initial assessment is the:

client's self-reporting of the pain experience. describe the : quality, location, and intensity physical assessment should follow the pain ass. the amount of pain meds. is important...meaningless without initial assessment family concerns secondary to issues with pain control

A client is to start chemotherapy to treat lung cancer. A venous access device has been placed to permit administration of chemo meds. Three days later at the scheduled appointment to receive chemo, the nurse assesses the client is dyspneic and the skin is warm and pale. The vital sings are blood pressure 80/30. pulse 132. resp 28, temp. 103, and O2 84%. The central line insertion site is inflamed. After calling the rapid response team, what should the nurse do next?

insert a peripheral intravenous fluid line and infuse normal saline. client is experiencing severe sepsis

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?

nonmobile mass with irregular edges Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction — not eversion — may be a sign of cancer.

When conducting a focused assessment of the resp. system, what should the nurse note as an early sign of laryngeal cancer?

persistent mild hoarseness Hoarseness occurs early in the course of most laryngeal cancers because the tumor prevents accurate approximation of the vocal cords during phonation. Large tumors eventually produce difficulty and pain in swallowing, but this is not an early sign. Foul breath and expectoration of blood are late symptoms. A nagging cough has no direct relationship to laryngeal cancer.

the nurse is reviewing the lab report for a client in hospice care with breast cancer and brain metastasis. According to the info in the chat, what should the nurse do next?

report the elevated Ca level 9.0-10.5 hypercalemia- malignant disease and metastases treated with fluids, furosemide, or administration of calcitonin. treatment failure: muscle weakness, changes in LOC, n/v, ab. pain, and dehydration. hospice care-needs palliative treatment comfort/risk reduction-hospice care

A client with lung cancer is cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife:

gives her husband a long acting or sustained release oral pain med regularly around the clock uses an immediate-release med (oxycodone) for breakthrough pain uses music for distraction as well as heat or cold in combination with meds has her husband use a pain-rating scale to measure the effectiveness at reaching his individual pain goal 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. Oral drug administration is the route of choice for economy, safety, and ease of use. Even severe pain requiring high doses of opioids can be managed orally as long as the client can swallow medication and has a functioning gastrointestinal system. Tolerance occurs due to the need for increasing doses to achieve the same pain relief and will not be avoided with the use of acetaminophen. Addiction is a complex condition in which the drug is used for psychological effect and not analgesia. Nurses need to educate families about the appropriate use of opioids and assure them that addiction is not a concern when managing cancer pain. Nonpharmacologic methods are useful as an adjunct to assist in pain control. Self-report is the best assessment of pain and is an individual response.