Pass Point Oncologic Disorders - ML7

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client?

Anticipatory grieving Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn't associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn't disfiguring and doesn't cause Disturbed body image. Chronic low self-esteem isn't an appropriate nursing diagnosis at this time because the diagnosis has just been made.

During a routine checkup, a nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer?

Kaposi's sarcoma Kaposi's sarcoma is the most common cancer associated with AIDS. Squamous cell carcinoma, multiple myeloma, and leukemia may occur in anyone and aren't associated specifically with AIDS.

A client with a suspected diagnosis of lung cancer has a bronchoscopy with biopsy. Following the procedure, what nurse should the nurse do?

Monitor the client for signs of pneumothorax. After a bronchoscopy with a biopsy, the nurse should monitor the client for signs of pneumothorax as well as hemorrhage. The client should not gargle with oral lidocaine; this will not allow the gag reflex to return. The client should not have any mediastinal discomfort after a bronchoscopy; if pain does occur, it should be reported promptly to the health care provider (HCP). It is not necessary to tell the client not to talk until the gag reflex returns.

A client diagnosed with terminal lung cancer expresses a desire to seek spiritual advice. Which intervention by the nurse best provides spiritual support for this client?

Ask who the client's spiritual advisor is and make the contact. The nurse may contact the client's spiritual advisor if the client so desires. The nurse can listen to the client, but spiritual support is best from someone proficient in that field, such as a spiritual advisor. It would be appropriate for the nurse to contact the clergy of another faith, only if no other resources are available and if the client consents. The nurse should speak with the client and get the information firsthand, before researching the admission history.

A client with a history of pancreatic cancer is revived following cardiac arrest but is determined to have suffered brain death. The family tells the nurse they want to donate any usable body organs so their loved one can live on in others. Which action by the nurse is appropriate?

Call the local organ procurement representative to meet with them. An organ procurement organization representative is the best person to discuss organ donation with the family. Not all clients are candidates for organ donation for transplantation. People who have active cancer or systemic illnesses such as hepatitis or HIV cannot donate for transplantation, but their organs may be donated for research. The client and the organs will be evaluated by transplant specialists to determine the best use of the organs.

A client is receiving monthly doses of chemotherapy for treatment of stage III colon cancer. Which laboratory results should the nurse report to the oncologist before the next dose of chemotherapy is administered? Select all that apply.

platelet count of 40,000/mm3 (40 X 109/L) white blood cell count of 2,300/mm3 (2.3 X 109/L) temperature of 101.2° F (38.4° C) Chemotherapy causes bone marrow suppression and risk of infection. A platelet count of 40,000/mm3 (40 X 109/L) and a white blood cell count of 2,300/mm3 (2.3 X 109/L) are low. A temperature of 101.2° F (38.4° C) is high and could indicate an infection. Further assessment and examination should be performed to rule out infection. The BUN, hemoglobin, and specific gravity values are normal.

Which nursing intervention is most appropriate for a client with multiple myeloma?

preventing bone injury When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict their fluid intake.

A client suspected of having colorectal cancer requires which diagnostic study to confirm the diagnosis?

sigmoidoscopy Used to visualize the lower GI tract, sigmoidoscopy and proctoscopy aid in the detection of two-thirds of all colorectal cancers. Stool Hematest detects blood, which is a sign of colorectal cancer; however, the test doesn't confirm the diagnosis. CEA may be elevated in colorectal cancer but isn't considered a confirming test. An abdominal CT scan is used to stage the presence of colorectal cancer.

Which is a risk factor for testicular cancer?

undescended testes Cryptorchidism (undescended testes) carries a greatly increased risk for testicular cancer. Undescended testes occurs in about 3% of male infants, with an increased incidence in premature infants. Other possible causes of malignancy include chemical carcinogens, trauma, orchitis, and environmental factors. Testicular cancer is not associated with early sexual relations in men, even though cervical cancer is associated with early sexual relations in women. Testicular cancer is not associated with seminal vesiculitis or epididymitis.

After the physician explains the risks and benefits of a clinical trial to a client, the client agrees to participate. Later that day, the client requests clarification of the process involved in the clinical trial. As a member of the multidisciplinary team, how should the nurse respond?

Provide the information requested. As part of the multidisciplinary team, the nurse is empowered to assist the client to better understand the process, as long as the nurse has an understanding of the treatment plan. The nurse shouldn't discourage the client from participating in the research study. Providing information to the client about the clinical trial isn't beyond the scope of nursing practice. The information doesn't need to come from the physician who originally presented the material to the client.

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.

A nurse is assessing a client with bone cancer pain. Which part of a thorough pain assessment is most significant for this client?

intensity Intensity is indicative of the severity of pain and is important for evaluating the efficacy of pain management. The cause and location of the pain cannot be managed, but the intensity of the pain can be controlled. The nurse and client can collaborate to reduce aggravating factors; however, the goal will ultimately be to reduce the intensity of the pain.

A client with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with

normal cellular processes during the S phase of the cell cycle. Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

A client recruited to participate in a clinical trial to treat non-Hodgkin's lymphoma voices concerns about the adverse effects of the treatment preventing the completion of the trial. What will the nurse tell the client to protect the principle of autonomy?

"You may withdraw at any time." Although the nurse must tell the client how adverse effects will be treated and the risks and benefits associated with participating in the trial, the most crucial element in protecting the ethical principle of autonomy is to inform the client that they may withdraw at any time without punitive consequences. Telling the client how participation in the trial will benefit others takes the focus from the client and does not support autonomy.

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 to 2 weeks. 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 evaluating if a client with Hodgkin's disease understands the monitoring that needs to be done at home between radiation treatments. Which statement would indicate that the client knows how to detect a major complication?

"I will take my temperature every day." Clients with Hodgkin's disease are extremely vulnerable to infection because of the defective immune responses caused by the tumor as well as the bone marrow depression and low white blood cell count that result from radiation therapy. Fever is the most sensitive indicator of infection and should be reported immediately so that treatment can be initiated.Measuring neck circumference is not related to any major complications associated with Hodgkin's disease and radiation therapy.Loss of hair is unusual with radiation therapy to the neck.Upper extremity circulation is not related to any major complication associated with Hodgkin's disease and radiation therapy.

A nurse is assessing an adult who has been receiving chemotherapy. The client has a platelet count of 22,000 cells/mm3 (22 × 109/L) and has petechiae on the lower extremities. What should the nurse should instruct the client to do?

Consult the health care provider. Petechiae are tiny, purplish, hemorrhagic spots visible under the skin. Petechiae usually appear when platelets are depleted. Bleeding gums or oozing of blood may accompany the petechiae, and the client should seek medical assistance immediately. Increasing iron in the diet will not improve the platelet count. Lotion will not treat the petechiae. Elevating the legs will not cause the petechiae to disappear.

A client receiving chemotherapy for cervical cancer indicates that she has an advance directive. She tells the nurse that she worries her children will not honor her wishes if her condition should worsen. In order to facilitate the honoring of the client's wishes, what should the nurse encourage the client to do?

Discuss her end-of-life wishes with her family. Family opposition does not override an advance directive. However, the client should ensure that family members know what her wishes are, even if they do not agree with them. After discussing her wishes with her family, the client can decide if she should seek additional legal advice, obtain legal documents, or name an outside proxy.

When the client who has had a modified radical mastectomy returns from the operating room to the recovery room, what should the nurse do first?

Ensure that the client's airway is free of obstruction. The highest priority when a nurse receives a client from the operating room is to assess airway patency. If the airway is not clear, immediate steps should be taken so that the client is able to breathe.Vital signs can be assessed after airway patency is assured.Assessing the patency and functioning of drainage tubes can be done after the airway is assessed and vital signs are taken.The dressing can be assessed once airway patency has been determined.

A client with advanced stomach cancer is scheduled for chemotherapy. As part of the chemotherapy regimen, the nurse expects the physician to order

Fluorouracil. Fluorouracil may be used to treat stomach cancer. Other drugs used to treat this disease include doxorubicin, methotrexate, cyclophosphamide, and vincristine. Cyclosporine is an immunosuppressant used in transplantation. Tamoxifen citrate and megestrol acetate are hormonal antineoplastic agents used to treat advanced breast cancer. Megestrol acetate may also be used to treat advanced endometrial and renal cancer.

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

"I clean my teeth gently several times per day." The client demonstrates understanding when they state that they will clean their teeth gently several times per day. Frequent gentle cleaning of the mouth or rinsing reduces bacteria build-up in the oral cavity, thus reducing the risk for oropharyngeal infection. Changing the toothbrush each month reduces the bacteria in the mouth for the first few uses only. Petroleum jelly moistens the lips, but doesn't prevent breakdown of the mucous membranes or reduce the risk for oropharyngeal infection. Alcohol-based products cause drying of the mucous membrane, increasing the likelihood of oropharyngeal infection.

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. 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 plan to include

chemotherapy exposure and risk factors. The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify the teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.

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?

planning a progressive activity regimen A progressive activity regimen may be prescribed to increase pulmonary function after surgical lung resection. Rehabilitation should include walking and some stair climbing as tolerated. It is not necessary at this point for the client to speak with someone who has had similar surgery. Depending on the surgeon's preference there may not be a dressing to change. There is no indication that the client would not be able to manage cleaning the house as her energy increases.

A young female client is receiving chemotherapy and mentions to the nurse that she and her husband are using a diaphragm for birth control. Which information is most important for the nurse to discuss?

infection control The risk of becoming neutropenic during chemotherapy is very high. Therefore, an inserted foreign object such as a diaphragm may be a nidus for infection. Although the nurse may wish to inform the client about the ease with which various contraceptive modalities may be used, the focus of this discussion should be on preventing an infection, which can be fatal for the neutropenic client. There are no data to suggest the client is at risk for acquiring a sexually transmitted disease. The client will not be experiencing body changes directly related to hormonal changes.

The nurse is planning care with a client with acute leukemia who has mucositis. What should the nurse advise the client to use for mouth care?

normal saline Simple rinses with saline or baking soda solution are effective and moisten the oral mucosa. Commercial mouthwashes and lemon-glycerin swabs contain glycerin and alcohol, which are drying to the mucosa and should be avoided. Brushing after each meal is recommended, but every 4 hours may be too traumatic. During acute leukemia, the neutrophil and platelet counts are often low and a soft-bristle toothbrush, instead of the client's usual brush, should be used to prevent bleeding gums.

Interprofessional management of ovarian cancer includes which measures? Select all that apply.

bilateral salpingo-oophorectomy to remove diseased organs referral to social services for supportive care Ovarian cancer is a malignant tumor of the ovary. Ovarian cancer is the fourth most common gynecologic cancer, but the most lethal. It is usually found in advanced stages because it is asymptomatic in early stages. Interprofessional management may involve chemotherapy, radiation therapy, surgery and supportive services. Chemotherapy may be used to achieve remission of the disease; it is not, however, curative. Surgery is the treatment of choice, usually involving total hysterectomy with bilateral salpingo-oophorectomy and removal of the omentum. Radiation therapy may be performed for palliative purposes only. The nurse should provide referral to home health services, financial assistance, psychological counseling, clergy, and other social services, as appropriate. Nutrition therapy for parenteral lipids is not part of management of ovarian cancer.

The nurse is providing discharge instructions about preventing infection to a client who had a modified radical mastectomy and will be pruning flowers when she returns to work. What is most important for the nurse to include in the teaching?

Wear protective gloves when gardening. This client is at risk for lymphedema and infection. Precautions to avoid creating an entry site for infection in the affected arm include wearing protective gloves, using cuticle cream, not cutting cuticles, using an electric razor, using a thimble when sewing, and avoiding having injections or blood drawn from that arm. The client does not need to avoid crowds or pay special attention to washing fresh fruits and vegetables, because there is no need for neutropenic precautions. Reporting a fever is important, but will not prevent infection for this client.