unit 4 stephs exam prepu

A patient with cancer who developed neutropenia several days ago has consequently been placed in a single-bed room that has positive pressure. His daughter has just come to visit her father after arriving from her home in another state and has asked you for his room number. You notice that the daughter has reddened eyes, sniffles, and a dry cough. What instruction should you provide to the daughter?

"Even though it might be difficult, it's best for your father's health if you get well before visiting him in person, since he's so vulnerable right now."

The nurse evaluates that a dying client is in the anger stage of reacting to her prognosis. Which of the following statements is most consistent with this interpretation?

"I took care of myself and it's not fair that this has happened."

A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse?

"I will notify the physician that the current dose of medication is not relieving your pain."

A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse?

"When your stay reaches 6 months, you will be recertified for a continued stay."

Which of the following is a nursing intervention for promoting self-care in the dying client?

Assist with personal hygiene.

A client who is receiving chemotherapy for esophageal cancer complains of "feeling sick to my stomach all the time." What is the best suggestion the nurse can make to help alleviate this client's nausea?

Eat low-fat foods.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?

Encourage fluid intake to dilute the urine.

A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client?

Fear

A decrease in circulating white blood cells (WBCs) is referred to as

Leukopenia

According to the tumor-node-metastasis (TNM) classification system, T0 means there is

No evidence of primary tumor

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

Stage 3 pressure ulcer on the left heel

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks?

Sun safety and use of sunscreen

The hospice nurse is caring for a 45-year-old mother of three young children in the client's home. During the most recent visit, the nurse has observed that the client has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. What goal of nursing interventions should the nurse identify?

Teaching family members how to interact with, and ensure safety for, the client with impaired cognition

A nurse is caring for a dying client. The family asks the nurse why there is a rattling in their loved one's chest. Which response is most appropriate?

There is an accumulation of fluid in the pulmonary circulation and secretions throughout the respiratory tract.

In which scenario would the nurse, caring for the palliative care client, encourage the treatment of chemotherapy?

When the chemotherapy can assist in managing distressing clinical symptoms

The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is:

care that will reduce the client's physical discomfort and manage clinical symptoms.

While offering end-of-life nursing care to a 72-year-old client with late-stage bone cancer, the nurse visits the client at home four times weekly. The nurse assesses the client each visit, monitoring the efficacy of pain medications, adjusting doses within physician ordered parameters, and discussing potential needs with the client's spouse, who is the primary caregiver. What is another very important assessment the nurse performs in the client's home?

caregiver's physical and emotional health

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.

A nurse who has just taken a new nursing position at an inpatient hospice begins to question if they are "strong enough" to withstand the continual dying of clients. The nurse's mentor relates the most effective method of dealing with client loss. What action is instrumental to being able to offer effective care and comfort to dying clients?

exploring personal mortality and feelings on death and dying

Why might a client who is approaching death suddenly vomit?

intestinal distention

A type of comprehensive care for clients whose disease is not responsive to cure is

palliative care.

A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome?

Emotional exhaustion

A client is dying, and the client and loved ones are in the grieving period. The nurse wants to support them in the grieving process. Which is the best intervention the nurse could perform?

Encourage loved ones to express their feelings.

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which nursing interventions should a nurse perform in such a situation?

Encourage the family members to express their feelings and listen to them in their frank communication.

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

Encourage the family members to express their feelings and listen to them in their frank communication.

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action?

Place the client in a private room.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior?

Progression

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions?

Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care

A medical nurse is providing end-of-life care for a client with metastatic bone cancer. The nurse notes that the client has been receiving oral analgesics for her pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?

Request the physician to prescribe analgesics by an alternative route.

Which of the following would be inconsistent as a common side effect of chemotherapy?

Weight gain

Which of the following should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a dying client?

Weight loss and inadequate food intake

According to the TNM classification system, T0 means there is

no evidence of primary tumor.

A 16-year-old female client experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. The nurse should determine that the client is meeting the goal of improved body image and self-esteem when the client:

requests that her family bring her makeup and wig.

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?

"I floss my teeth every morning."

A patient with a diagnosis of renal cell carcinoma is being treated with chemotherapy. During a previous round of chemotherapy, the patient's tumor responded well to treatment but the chemotherapy caused intense nausea and vomiting. How should the patient's potential nausea and vomiting be addressed during this current round of treatment?

Administer antiemetics in anticipation of the patient's nausea.

A nurse who sits on the hospital's ethics committee is reviewing a complex case that has many of the characteristics of assisted suicide. Which of the following would be an example of assisted suicide?

Administering a lethal dose of medication to a client whose death is imminent

The nurse in a pediatric ICU is caring for a child who is dying of sickle cell disease. The child's mother has been unable to eat or sleep and can talk only about her impending loss and the guilt she feels about the child's pain and suffering. What intervention has the highest priority?

Allowing the client to express her feelings without judging her

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

Allows for the nurse to facilitate the grieving process

A family of a dying client reports that their loved one is experiencing more shortness of breath. Which nursing intervention is most appropriate at this time?

Call the health care provider to obtain an oxygen order

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?

Wear disposable gloves and protective clothing.

A client with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this client's plan of care?

Limit the time that visitors spend at the client's bedside.

A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign?

Liver function tests (LFTs)

Mr. Hosa is a 68-year-old man who is in the end stages of pancreatic cancer. His care team has suggested the possibility of hospice care but Mr. Hosa is opposed, stating, "A hospice is just a place to wait to die." Which of the following statements should underlie the nurse's response to Mr. Hosa?

Meaningful living can take place despite terminal illness.

Shortly after a client's death from a long-term illness, his daughter says to the nurse, "Things changed so suddenly. I told him yesterday how much I loved him but that it was OK to let go if that's what he wanted." The nurse would identify this as what phenomenon for the daughter?

Waiting for permission

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse?

It lowers serum and uric acid levels.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching?

"I'm worried I'll expose my family members to radiation."

An elderly client has been diagnosed with metastatic cancer and has a poor prognosis of survival. The family asks the nurse for advice on whether to tell the client of the diagnosis or to keep it quiet. Which is the best response from the nurse?

"In my experience, clients who know are more likely to be involved with their plan of care."

A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give?

"Tell me more about what's on your mind."

A client has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The client states that he is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?

"You are anxious about the surgery. Do you see smoking as helping?"

A client has been diagnosed with a neoplasm and is seeking further information and possible treatment. The primary care physician described the neoplasm as "insidious." What does the word "insidious" mean?

A client has been diagnosed with a neoplasm and is seeking further information and possible treatment. The primary care physician described the neoplasm as "insidious." What does the word "insidious" mean?

An oncology client has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis?

Avoid rubbing or scratching the affected area

Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer?

Biopsy of the axillary lymph nodes

The nurse is caring for a client who has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The client states that he would like to die at home, but the team believes that the client's care needs are unable to be met in a home environment. What might the nurse suggest as an alternative?

Discuss a referral for hospice care.

The nurse is admitting a client with a diagnosis of ovarian cancer. She has just been told that her ovarian cancer is terminal. What question should the nurse include in a spiritual assessment?

Does she have a sense of peace of mind and a purpose to her life?

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?

Durable power of attorney for health care

The nurse at the clinic explains to the patient that the surgeon will be removing a mole on the patient's back that has the potential to develop into cancer. The nurse informs the patient that this is what type of procedure?

Prophylactic

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority?

Risk for infection

A young client has been diagnosed with cancer that has metastasized to the lungs. During client education, the client's mother asks about tumor staging and its relation to her child's condition. What stage would the nurse expect this client's tumor to be assigned?

Stage IV

The nursing instructor is discussing the difference between normal cells and cancer cells with the pre-nursing class in pathophysiology. What would the instructor cite as a characteristic of a cancer cell?

The cell membrane of malignant cells contains proteins called tumor-specific antigens.

The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?

The principle of autonomy

Despite having been administered prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea?

Use imagery, humor, and progressive relaxation

In spite of administering the prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea?

Use imagery, humor, and progressive relaxation

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?

"It will enable the patient to remain home if that is what is desired."

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is

"You will need to practice birth control measures."

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise?

Avoid spicy and fatty foods.

A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client's symptoms?

Client's goals

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services?

Clients and families view hospice care as giving up

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following?

Explore own feelings on mortality and death and dying.

A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?

Extravasation

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?

Ham and bacon

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth?

Provide gentle oral care after each meal.

A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis?

Red, open sores on the oral mucosa

The nurse is providing home care to a dying client and has noticed over the course of several weeks that the client's daughter is usually quiet and withdrawn when in the client's room. Which intervention should the nurse perform in this situation?

Sit with the client's daughter privately and encourage her to express her feelings frankly.

The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?

Smoking cessation

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?

Stomatitis

A nurse has been providing in-home hospice care to an older adult client with lung cancer for more than six months. The family asks the nurse how long the Medicare hospice services will continue. What is the nurse's best response?

The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition.

A client's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client's care, the nurse should identify what primary aim?

To prevent and relieve suffering

A client with metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy?

To prevent metastasis

The physician is attending to a 72-year-old client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation?

To prevent the formation of new cancer cells