Adult 1 Exam
Strategies to prevent recurrence of renal calculi
Drink 12 glasses of water a day, avoid coffee, tea and cola, make dietary modifications, prevent uric acid stones with allopurinol
Pt taking cyclophosphamide, be cautious administering because it poses fatal side effect of:
Hemorrhagic cystitis
Postop care following colon resection includes:
--Monitor and treat pain, eval pain relief measures --Provide wound care using surgical aseptic technique --Advise pt to use stool softeners to prevent straining
Cancer screening recommendations for adults
--Women 45-54 should get mammograms every year. --Women 55+: mammograms every 2 years Starting at age 50, both men and women should follow one of these testing plans: --Colonoscopy every 10 years --Yearly fecal immunochemical test Cervical cancer testing should start at age 21. --Women 21-29 should have a Pap test done every 3 years. --Women 30-65 should have a Pap test plus an HPV test (called "co-testing") done every 5 years, but it's OK to have a Pap test alone every 3 years.
Radiation protection: distance to maintain from client?
3 ft (1m)
Contact with patient on radiation therapy should be limited to how many minutes to promote safety for personnel?
5 min each encounter
Patients may reduce the risk of developing cancer using health promotion strategies. Identify strategies which can reduce the risk of developing cancer (select all that apply.). a. Control weight b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake
A, C, D, E, F
A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective? a. "I can buy some aloe vera gel to use on the area." b. "I will expose the treatment area to a sun lamp daily." c. "I can use ice packs to relieve itching in the treatment area." d. "I will scrub the area with warm water to remove the scales."
ANS: A Aloe vera gel and cream may be used on the radiated skin area.
Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? a. A bland, low-fiber diet b. A high-protein, high-calorie diet c. A diet high in fresh fruits and vegetables d. A diet emphasizing whole and organic foods
ANS: A Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat.
After change-of-shift report, which patient should the nurse assess first? a. Patient with a urethral stricture who has not voided for 12 hours b. Patient who has cloudy urine after orthotopic bladder reconstruction c. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg d. Patient who voided bright red urine immediately after returning from lithotripsy
ANS: A The patient information suggests acute urinary retention, a medical emergency. The nurse will need to assess the patient and consider whether to insert a retention catheter.
The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient swims a mile 3 days a week. b. The patient snacks frequently during the day. c. The patient showers everyday with a mild soap. d. The patient has a history of dental caries with amalgam fillings.
ANS: A The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period.
When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP assists the patient to use dental floss after eating. b. The UAP adds baking soda to the patient's saline oral rinses. c. The UAP puts fluoride toothpaste on the patient's toothbrush. d. The UAP has the patient rinse after meals with a saline solution.
ANS: A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding.
The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening
ANS: A, C, D, E The patient's age, gender, and history indicate a need for screening and/or teaching about colorectal cancer, mammography, Pap smears, and sunscreen.
A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)? a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work done.
ANS: A, C, E Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.
The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years b. Family history of colorectal cancer and consumes a high-fiber diet c. Limits fat consumption and has regular mammography and Pap screenings f. Exercises five times every week and does not consume alcoholic beverages
ANS: A.
The nurse preparing for the annual physical exam of a 50-year-old man will plan to teach the patient about a. endoscopy. b. colonoscopy. c. computerized tomography screening. d. carcinoembryonic antigen (CEA) testing.
ANS: B At age 50, individuals with an average risk for colorectal cancer (CRC) should begin screening for CRC. Colonoscopy is the gold standard for CRC screening.
Which assessment finding in a 36-year-old patient is most indicative of a need for further evaluation? a. Bilateral breast nodules that are tender with palpation b. A breast nodule that is 1 cm in size, nontender, and fixed c. A breast lump that increases in size before the menstrual period d. A breast lump that is small, mobile, with a rubbery consistency
ANS: B Painless and fixed lumps suggest breast cancer.
The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patient's bedpan. b. The UAP stands by the patient's bed for 30 minutes talking with the patient. c. The UAP places the patient's bedding in the laundry container in the hallway. d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.
ANS: B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited.
A 74-year-old patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test result. The nurse explains that the test is used to a. identify any metastasis of the cancer. b. monitor the tumor status after surgery. c. confirm the diagnosis of a specific type of cancer. d. determine the need for postoperative chemotherapy.
ANS: B CEA is used to monitor for cancer recurrence after surgery.
The home health nurse cares for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."
ANS: B Fatigue can be a dose-limiting toxicity for use of biologic therapies.
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? a. The patient ambulates several times a day in the room. b. The patient's visitors bring in some fresh peaches from home. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.
ANS: B Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present.
To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating a. milk and cheese. b. sardines and liver. c. legumes and dried fruit. d. spinach, chocolate, and tea.
ANS: B Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.
The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include? a. Saline-filled implants are placed under the pectoral muscles. b. Recovery from the TRAM surgery takes at least 6 to 8 weeks. c. Muscle tissue removed from the back is used to form a breast. d. TRAM flap procedures may be done in outpatient surgery centers.
ANS: B Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires postoperative hospitalization.
Which patient statement indicates that the nurse's teaching about tamoxifen (Nolvadex) has been effective? a. "I can expect to have leg cramps." b. "I will call if I have any eye problems." c. "I should contact you if I have hot flashes." d. "I will be taking the medication for 6 to 12 months."
ANS: B Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen.
A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.
ANS: B Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider.
The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.
ANS: B Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein.
A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patient's self-esteem? a. Tell the patient to limit social contacts until regrowth of the hair occurs. b. Encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss. d. Inform the patient that hair usually grows back once the chemotherapy is complete.
ANS: B The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats.
Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? a. Blood in urine b. Left flank bruising c. Left flank discomfort d. Decreased urine output
ANS: D Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to report a drop in urine output.
Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development? a. "Exercise every day for 30 minutes." b. "Follow smoking cessation recommendations." c. "Following a vitamin regime is highly recommended." d. "I recommend excision of the cancer as soon as possible."
ANS: B The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development.
The nurse should include which food choice when providing dietary teaching for a patient scheduled to receive external beam radiation for abdominal cancer? a. Fresh fruit salad b. Roasted chicken c. Whole wheat toast d. Cream of potato soup
ANS: B To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains
The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? a. Ask the patient if the site hurts. b. Turn off the chemotherapy infusion. c. Call the ordering health care provider. d. Administer sterile saline to the reddened area.
ANS: B. Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation, the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage.
Which patient is statistically and medically at the highest risk of developing cancer? a. A 68-yr-old white woman who has BRCA-1 gene and is obese b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily c. An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol d. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.
ANS: B. The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk.
The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will determine how much longer I have to live." c. "The biopsy will help decide the treatment for my enlarged prostate." d. "The biopsy will indicate whether the cancer has spread to other organs."
ANS: C A biopsy is used to determine whether the prostate enlargement is benign or malignant, and determines the type of treatment that will be needed.
The nurse is providing preoperative teaching for a 61-year-old man scheduled for an abdominal-perineal resection. Which information will the nurse include? a. Another surgery in 8 to 12 weeks will be used to create an ileal-anal reservoir. b. The patient will begin sitting in a chair at the bedside on the first postoperative day. c. The patient will drink polyethylene glycol lavage solution (GoLYTELY) preoperatively. d. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria.
ANS: C A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection. A permanent colostomy is created with this surgery.
A patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? a. Use Dial soap to feel clean and fresh. b. Scented lotion can be used on the area. c. Avoid heat and cold to the treatment area. d. Wear the new bra to comfort and support the area.
ANS: C Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage.
A 53-year-old woman at menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. b. HT does not appear to increase the risk for breast cancer unless there are other risk factors. c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.
ANS: C Because HT has been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HT.
The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? a. 35-year-old patient who has wet desquamation associated with abdominal radiation b. 42-year-old patient who is sobbing after receiving a new diagnosis of ovarian cancer c. 24-year-old patient who received neck radiation and has blood oozing from the neck d. 56-year-old patient who developed a new pericardial friction rub after chest radiation
ANS: C Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first.
A 71-year-old patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? a. Teach about a low-residue diet. b. Monitor output from the stoma. c. Assess the perineal drainage and incision. d. Encourage acceptance of the colostomy stoma.
ANS: C Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound.
Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Check blood pressure (BP) on both right and left arms. b. Avoid isometric exercise on the right arm. c. Assist with application of a compression sleeve. d. Keep the right arm at or below the level of the heart.
ANS: C Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema.
The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the health care provider? a. The patient complains of fatigue. b. The patient eats only 25% of meals. c. The patient's apical pulse is irregular. d. The patient's white blood cell (WBC) count is 5000/µL.
ANS: C Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy.
Which activity in the care of a 48-year-old female patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? a. Document the appearance of the stoma. b. Place a pouching system over the ostomy. c. Drain and measure the output from the ostomy. d. Check the skin around the stoma for breakdown.
ANS: C Draining and measuring the output from the ostomy is included in UAP education and scope of practice.
A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Provide teaching about the importance of nutritional intake. d. Apply the ordered anesthetic gel to oral lesions before meals.
ANS: D Because the etiology of the patient's poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats.
After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/μL after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) d. Patient who is worried about getting the prescribed long-acting opioid on time
ANS: C Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis.
The nurse observes unlicensed assistive personnel (UAP) taking the following actions when caring for a female patient with a urethral catheter. Which action requires that the nurse intervene? a. Taping the catheter to the skin on the patient's upper inner thigh b. Cleaning around the patient's urinary meatus with soap and water c. Disconnecting the catheter from the drainage tube to obtain a specimen d. Using an alcohol-based gel hand cleaner before performing catheter care
ANS: C The catheter should not be disconnected from the drainage tube because this increases the risk for urinary tract infection (UTI).
After a ureterolithotomy, a female patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care? a. Provide teaching about home care for both catheters. b. Apply continuous steady tension to the ureteral catheter. c. Call the health care provider if the ureteral catheter output drops suddenly. d. Clamp the ureteral catheter off when output from the urethral catheter stops.
ANS: C The health care provider should be notified if the ureteral catheter output decreases because obstruction of this catheter may result in an increase in pressure in the renal pelvis.
During a routine health examination, a 40-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Teach the patient about the need for a colonoscopy at age 50. b. Teach the patient how to do home testing for fecal occult blood. c. Obtain more information from the patient about the family history. d. Schedule a sigmoidoscopy to provide baseline data about the patient.
ANS: C The patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning.
A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. Rinse the mouth before and after each meal and at bedtime with a saline solution.
ANS: D The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care.
A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate? a. Add strained baby meats to foods such as casseroles. b. Teach the patient about foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Add extra spice to enhance the flavor of foods that are served.
ANS: C The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste.
A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient two ounces of a citrus fruit beverage during treatments.
ANS: C Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals.
A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? a. "When your hair grows back, it will be patchy." b. "Don't use your curling iron, and that will slow down the loss." c. "You can get a wig now to match your hair so you will not look different." d. "You should contact "Look Good, Feel Better" to figure out what to do about this."
ANS: C. The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered.
The nurse teaches a 64-year-old woman to prevent the recurrence of renal calculi by a. using a filter to strain all urine. b. avoiding dietary sources of calcium. c. choosing diuretic fluids such as coffee. d. drinking 2000 to 3000 mL of fluid a day.
ANS: D A fluid intake of 2000 to 3000 mL daily is recommended to help flush out minerals before stones can form.
The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? a. Generalized muscle aches b. Complaints of nausea and anorexia c. Oral temperature of 100.6° F (38.1° C) d. Crackles heard at the lower scapular border
ANS: D Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider.
A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Teaching the patient how to avoid injury to the left arm b. Assessing the patient's range of motion for the left arm c. Evaluating the patient's understanding of instructions about drain care d. Administering an analgesic 30 minutes before scheduled arm exercises
ANS: D LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics.
When the nurse is working in the women's health care clinic, which action is appropriate to take? a. Teach a healthy 30-year-old about the need for an annual mammogram. b. Discuss scheduling an annual clinical breast examination with a 22-year-old. c. Explain to a 60-year-old that mammography frequency can be reduced to every 3 years. d. Teach a 28-year-old with a BRCA-1 mutation about magnetic resonance imaging (MRI).
ANS: D MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A young woman should have a clinical breast exam every 3 years. Annual mammograms are recommended for women over 50.
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit of 30% b. Platelets of 95,000/μL c. Hemoglobin of 10 g/L d. White blood cell (WBC) count of 2700/μL
ANS: D The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed.
The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation." d. "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured."
ANS: D The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.
A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should a. place ice packs around the stoma. b. notify the surgeon about the stoma. c. monitor the stoma every 30 minutes. d. document stoma assessment findings.
ANS: D The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required.
The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that a. hot flashes may occur with the medication. b. serum electrolyte levels will be drawn monthly. c. the patient will need frequent eye examinations. d. the patient should call if she notices ankle swelling.
ANS: D Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure.
Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration? a. Teach the patient to rest the brain by avoiding new activities. b. Teach that "chemo-brain" is a short-term effect of chemotherapy. c. Report patient symptoms immediately to the health care provider. d. Suggest use of a daily planner and encourage adequate rest and sleep.
ANS: D Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop "chemo-brain" while receiving chemotherapy.
The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? a. Increase intake of liquids at mealtime to stimulate the appetite. b. Serve three large meals per day plus snacks between each meal. c. Avoid the use of liquid protein supplements to encourage eating at mealtimes. d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
ANS: D. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat.
Lung cancer pt to receive influenza vax and pneumococcal vax
Administer vax's in different arms
Which should nurse question if client is on radiation therapy?
Aspirin q4h—radiation can cause PLT decrease, aspirin is a blood thinner
A patient has been diagnosed with urinary tract calculi that are high in uric acid. Which foods will the nurse teach the patient to avoid (select all that apply)? a. Milk b. Liver c. Spinach d. Chicken e. Cabbage f. Chocolate
B, D Meats contain purines, which are metabolized to uric acid.
The MOST effective method of administering a chemo agent that is a vesicant is to a. give it PO b. give it intraarterially c. use an Ommaya reservoir d. use a CVAD
D.
Lab findings indicating allopurinol has been effective
Decreased serum uric acid levels
Modified tumor lumpectomy scheduled. Postop, to restore arm function,
Emphasize regular exercises for affected shoulder to increase ROM
Nurse providing education r/t colon cancer to women 45-65 years of age, include:
Fecal occult blood tests should be done annually at age 50
Classic symptoms that define breast cancer:
Firm, nontender, nonmobile mass; abnormal nipple discharge; solitary, irregularly shaped mass
Tests for individuals with familial adenomatous polyposis
Genetic testing during childhood Colorectal screening beginning at puberty Annual colonoscopy starting @ 16yo Colonoscopy, sigmoidoscopy, barium enema, and virtual colonoscopy (CT or MRI) used to discover polyps Colon and rectum removed by age 25-- protocolectomy with ileostomy is done pts also @ risk for cancers of thyroid, small intestine, liver, and brain
Diet restrictions for uric acid calculi
Low-purine diet: no sardines, herring, mussel, liver, kidney, goose, venison, meat soups, sweetbread, chicken, salmon, crab, veal, mutton, bacon, pork, beef, or ham DECREASE MEAT CONSUMPTION
Diet restrictions for calcium oxalate calculi
Low-sodium diet, low oxalate diet: no spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, chocolate, instant coffee, tea, Wor sauce
N/V is an expected side effect of chemo. Which drug should be administered to chemo pt to prevent N/V?
Metoclopramide
Raloxifene
Reduces the risk of breast cancer in postmenopausal women with osteoporosis or at high risk for breast cancer.
Nurse learns pt has transverse colostomy. You would expect the pt to have:
Semi-formed stools, need to monitor fluid balance
Pt with breast cancer, tumor up to 5cm, axillary and neck lymph node involvement. Stage?
Stage 2
Treatment choices for stage 1 non-small cell lung cancer
Surgery-- removal of affected lobe and lymph nodes Chemotherapy and radiation after surgery
7. Radiation therapy, which is false? o Therapy is painless o To promote safety, client is assisted while machine is in operation o Client may communicate concerns, needs, discomforts while machine is operating o Safety precautions necessary only during time of radiation
To promote safety, client is assisted while machine is in operation—F
Location of most breast cancers
Upper outer quadrant (the location of most of the glandular tissue of the breast)
Tamoxifen
Used for estrogen-dependent breast tumors in premenopausal women.
Pt with breast cancer has had lumpectomy, with sentinel lobe biopsy positive for cancer. Explain results that are most favorable
Well-differentiated tumor Tumor is estrogen-dependent
Estradiol
Will increase the growth of estrogen-dependent tumors
Busulfan
alkylating antineoplastic agent used before stem cell transplants and to treat blood cancers (leukemia) slows/stops the growth of cancer cells
Anastrazole
aromatase inhibitor treats breast cancer in post-menupausal women decreases the amount of estrogen the body makes
Succimer
chelating agent binds to lead in the bloodstream and allows it to be passed through the urine (treats lead poisoning)
Cytarabine, antimetabolite that can cause syndrome that includes:
o Fever o Myalgia o Bone pain o Chest pain o Rash o Conjunctivitis o Malaise
Pt teaching about triple negative breast cancer
progesterone, estrogen, HER 2/neu --> not present in the tumor; using chemo is still an effective option but treatment may need altered.
For relief of cytarabine, administer
steroids
Metoclopramide
treats nausea and vomiting
Allopurinol
xanthine oxidase inhibitor decreases serum and urine concentrations of uric acid