Prep-u oncology

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. Explanation: 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.

The nurse is teaching the family of a client diagnosed with leukemia about ways to prevent infection. Which instruction has the most impact?

Maintaining an intact skin integrity

A medication nurse is preparing to administer 9 a.m. medications to a client with liver cancer. Which consideration is the nurse's highest priority?

Metabolism of the medication

After a lobectomy for lung cancer, the nurse instructs the client to perform deep-breathing exercises to:

expand the alveoli and increase lung surface available for ventilation.

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

Achieve effective management of bone pain.

The client with a laryngectomy does not want to be observed by the family because the opening in the throat is "disgusting." The nurse should:

explore why the client believed the stoma is "disgusting." Explanation: Changes in body image are expected after a laryngectomy, and the nurse should first explore what is upsetting the client the most at this time. Many clients are concerned about how their family members will respond to the physical changes that have occurred as a result of a laryngectomy, but discussing the importance of family support is not helpful; instead, the nurse should allow the client to communicate any negative feelings or concerns that exist because of the surgery. The client's feelings are not related to a knowledge deficit, and therefore, it is too early to begin teaching about stoma care. It is also not helpful to offer reassurances about the change in appearance; the client will require time to adjust to the changed body image.

A client diagnosed with seminomatous testicular cancer expresses fear and questions the nurse about his prognosis. The nurse should base the response on the knowledge that:

testicular cancer has a cure rate of 90% when diagnosed early. Explanation: When diagnosed early and treated aggressively, testicular cancer has a cure rate of about 90%. Treatment of testicular cancer is based on tumor type, and seminoma cancer has the best prognosis. Modes of treatment include combinations of orchiectomy, radiation therapy, and chemotherapy. The chemotherapeutic regimen used currently is responsible for the successful treatment of testicular cancer. The nurse should not indicate to the client that the cancer will be cured, even though cure rates are high.

A client with a diagnosis of cancer is frequently disruptive and challenges the nurse. This behavior may be caused by:

uncertainty and an underlying fear of recurrence

The nurse is assessing a client who is suspected of being in the early symptomatic stages of human immunodeficiency virus (HIV) infection. Which indications of infection should the nurse detect during this stage?

whitish yellow patches in the mouth Explanation: Oropharyngeal candidiasis, or thrush, is the most common infection associated with the early symptomatic stages of HIV infection. Thrush is characterized by whitish yellow patches in the mouth. Various other opportunistic diseases can occur in clients with HIV infection, but they tend to occur later, after the diagnosis of acquired immunodeficiency syndrome has been made. Dyspnea can be indicative of pneumonia, which is caused by a variety of infective organisms. Bloody diarrhea is indicative of cytomegalovirus infection. Hyperpigmented lesions are indicators of Kaposi's sarcoma.

On the night before a 58-year-old wife and mother is to have a lobectomy for lung cancer, she remarks to the nurse, "I am so scared of this cancer. I should have quit smoking years ago. Now I have brought all this fear and sadness on myself and now my family." The nurse should tell the client:

"It is okay to be scared. What is it about cancer that you are afraid of?" Explanation: Acknowledging the basic feeling that the client expressed and asking an open-ended question allows the client to explain her fears. Saying, "It is normal to be scared. We will help you through it," does not focus on the client's feelings; rather, it gives reassurance. Asking if the client feels guilty for having smoked assumes guilt, which might be present, but additional information is needed to confirm. Telling the client not to be so hard on herself does not acknowledge the client's feelings at all.

To combat the most common adverse effects of chemotherapy, a nurse should prepare to do which of the following?

Administer an antiemetic. Explanation: Antiemetics, antihistamines, and certain steroids treat nausea and vomiting, which is a common adverse effect of chemotherapy. Lack of knowledge about adverse effects or information about support groups are important, but they are not common adverse effects. Clients often require appetitie enhancers to stimulate appetite after receiving chemotherapy. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications.

A nurse is caring for a client with bronchogenic carcinoma. Which nursing intervention takes highest priority?

Removing pulmonary secretions

The nurse is instructing a client on how to care for skin that has become dry after radiation therapy. Which statement by the client indicates that the client understands the teaching?

"It is safe to apply a nonperfumed lotion to my skin." Explanation: Irradiated skin can become dry and irritated, resulting in itching and discomfort. The client should be instructed to clean the skin gently and apply nonperfumed, nonirritating lotions to help relieve dryness. Taking an antihistamine does not relieve the skin dryness that is causing the itching. Heat should not be applied to the area because it can cause further irritation. Medicated ointments should not be applied to the skin without the prescription of the radiation therapist.

A client receiving chemotherapy for metastatic colon cancer is admitted to the hospital because of prolonged vomiting. Assessment findings include irregular pulse of 120 bpm, blood pressure 88/48 mm Hg, respiratory rate of 14 breaths/min, serum potassium of 2.9 mEq/L (2.9 mmol/L), and arterial blood gas—pH 7.46, PCO2 45 mm Hg (6.0 kPA), PO2 95 mm Hg (12.6 kPa), bicarbonate level 29 mEq/L (29 mmol/L). The nurse should implement which prescription first?

5% Dextrose in 0.45% normal saline with KCl 40 mEq/L at 125 mL/h Explanation: The vital signs suggest that the client is dehydrated from the vomiting, and the nurse should first infuse the IV fluids with the addition of potassium. There is no indication that the client needs oxygen at this time since the PO2 is 95 (12.6 kPa). Although the client has a rapid and irregular pulse, the infusion of fluids may cause the heart rate to return to normal, and the 12-lead ECG can be prescribed after starting the intravenous fluids.

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?

Closely observe the client's skin for petechiae and bruising. Explanation: The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.

What should a male client older than age 50 do to help ensure early identification of prostate cancer?

Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. Explanation: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastasis

The client with leukemia received induction chemotherapy 2 days ago and is now reporting severe diarrhea, decreased urination, cardiac dysrhythmias, and parasthesias with tetany. Laboratory reports reveal hyperkalemia, hyperuricemia, and hypocalcemia. Which of the following actions would the nurse anticipate?

IV fluids to increase urine output and allopurinol to inhibit uric acid. Explanation: The client likely has tumor lysis syndrome which occurs when a person with cancer (such as leukemia) initiate treatment, causing the rapid destruction and breakdown of large numbers of cells. The syndrome results in the signs and symptoms noted above as well as hyperuricemia, hyperkalemia, hyperphosphatemia, renal failure, and hypocalcemia. Early recognition is important to prevent renal damage. Increased IV fluids will flush the cellular debris from the system while increasing urine volume and restoring alkalinity, and allopurinol to decrease production of uric acid. Fluids should not contain potassium.

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?

Identify available resources for the client and family.

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement?

Related to impaired balance Explanation: A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.

A client with testicular cancer is scheduled for a right orchiectomy. The day before surgery, the client tells the nurse that he is concerned about the effect that losing a testicle will have on his manhood. Which information about orchiectomy should form the basis for the nurse's response?

Sexual drive and libido are unchanged. Explanation: The remaining testicle undergoes hyperplasia and produces enough testosterone to maintain sexual drive, libido, and secondary sexual characteristics. Testosterone levels will return to normal. Sperm count can decrease after a unilateral orchiectomy; this is attributed to the stress of the surgery. Secondary sexual characteristics do not change because the remaining testicle continues to produce testosterone.

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?

Testicular cancer is a highly curable type of cancer. Explanation: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger, not older, men.

A client with cancer is uncertain about how to cope with all the issues that will arise. The nurse can best support the coping behaviors of a client with cancer by:

helping the client identify available resources.

A nurse is assessing a client with metastatic lung cancer. The nurse should assess the client specifically for:

hoarseness. Explanation: Hoarseness may indicate metastatic disease to the recurrent laryngeal nerve and is commonly noted with left upper lobe lung tumors. Diarrhea and constipation are not associated with lung cancer. Weight loss, not weight gain, can be a symptom of extensive disease.

A client with metastatic brain cancer is admitted to the oncology floor. According to the Self-Determination Act of 1991 concerning the execution of an advance directive, the hospital is required to:

inform the client or legal guardian of their rights to execute an advance directive.

The primary reason that a herpes simplex virus (HSV) infection is a serious concern to a client with human immunodeficiency virus (HIV) infection is that it:

is an acquired immunodeficiency virus (AIDS)-defining illness. Explanation: HSV infection is one of a group of disorders that, when diagnosed in the presence of HIV infection, are considered to be diagnostic for AIDS. Other AIDS-defining illnesses include Kaposi's sarcoma; cytomegalovirus of the liver, spleen, or lymph nodes; and Pneumocystis carinii pneumonia. HSV infection is not curable and does not cause severe electrolyte imbalances. Human papillomavirus can lead to cervical cancer.

A right orchiectomy is performed on a client with a testicular malignancy. The client expresses concerns regarding his sexuality. The nurse should base the response on the knowledge that the client:

should retain normal sexual drive and function. Explanation: Unilateral orchiectomy alone does not result in impotence if the other testis is normal. The other testis should produce enough testosterone to maintain normal sexual drive, functioning, and characteristics. Sperm banking before treatment is commonly recommended because radiation or chemotherapy can affect fertility.

Cancer prevalence is defined as:

the number of persons with cancer at a given point in time. Explanation: The word prevalence in a statistical setting is defined as the number of cases of a disease present in a specified population at a given time.

On an oncology unit, the nurse hears noises coming from a client's room. The client is found throwing objects at the walls and has just picked up the phone and is screaming, "How can God do this to me? It is the third type of cancer I have had. I have gone through all the treatment for nothing." In what order of priority from first to last should the nurse make the interventions? All options must be used.

"Please put the telephone down so we can talk." "I can hear how upset you are about the cancer." "Tell me what you are feeling right now." "I wonder if you would like to talk to a clergyman."

A young man with early-stage testicular cancer is scheduled for a unilateral orchiectomy. The client confides to the nurse that he is concerned about what effects the surgery will have on his sexual performance. Which response by the nurse provides accurate information about sexual performance after an orchiectomy?

"Because your surgery does not involve other organs or tissues, you will likely not notice much change in your sexual performance." Explanation: Although there may not be a big change in sexual function with a unilateral orchiectomy, the loss of a gonad and testosterone may result in decreased libido and sterility. Sperm banking may be an option worth exploring if the number and motility of the sperm are adequate. Remember, the population most affected by testicular cancer is generally young men aged 15 to 34, and in this crucial stage of life, sexual anxieties may be a large concern

At what age is an individual most at risk for acquiring acute lymphocytic leukemia (ALL)?

4 to 12 years Explanation: The peak incidence of ALL is at 4 years of age. ALL is uncommon after 15 years of age. The median age at incidence of CML is 40 to 50 years. The peak incidence of AML occurs at 60 years of age. Two-thirds of cases of chronic lymphocytic leukemia occur in clients older than 60 years of ag