Bone/Head & Neck Cancer

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the clients psychosocial needs? a. Assess the clients coping skills and support systems. b. Explain that the surgery leads to a longer life expectancy. c. Refer the client to the social worker or hospital chaplain. d. Reinforce physical therapy to aid with ambulating normally.

A

The client preparing to go home after a radical neck dissection for cancer is crying. When the nurse asks why he is crying, the client writes, "I know I shouldn't cry because this surgery may well save my life, but I can't believe how changed my appearance is." What is the nurse's best response? A. "It is all right to cry. Mourning this loss is important in getting past this point." B. "You're right. It is silly to carry on like this when the surgery may cure you." C. "Would you like to talk to someone who also has had a laryngectomy?" D. "How have you coped with difficult situations in the past?"

A

The nurse is preparing Cyclophosphaide (Cytoxan). Safe handling of the drug should be implemented to protect the nurse from injury. Which of the following action by the nurse should be corrected? a. The nurse should wear mask and gloves b. Air bubbles should be expelled on wet cotton c. Label the hanging IV bottle with "ANTINEOPLASTIC CHEMOTHERAPY" sign d. Vent vials after mixing

A

What instructions should the nurse give to the client for stoma care at home after a laryngectomy? A. "Gently wash the stoma with soap and water, then apply a water-based lubricant." B. "Use cotton-tipped applicators to clean out the stoma lumen at least twice per day." C. "Use a syringe or Water Pik to irrigate the stoma with a solution of sterile normal saline and peroxide." D. "Gently scrape crusts away from the stoma opening with a tongue blade and apply petroleum jelly to the external stump."

A

What is the most common primary malignancy of the bone (excluding hematopoietic malignancies)? a. Osteosarcoma b. Ewing's sarcoma c. Osteoid osteoma d. Fibrosarcoma

A

When initially teaching a patient the supraglottic swallow following a radical neck dissection, with which food or fluid should the nurse begin? a. Cola b. Applesauce c. French fries d. White grape juice

A

When staff assignments are made for the care of patients who are receiving chemotherapy, what is the major consideration regarding chemotherapeutic drugs? a. During preparation, drugs may be absorbed through the skin or inhaled b. Many chemotherapeutic drugs are vesicants c. Chemotherapeutic drugs are frequently given through central venous access devices d. Oral and venous routs of administration are the most common

A

You are monitoring your patient who is at risk for spinal cord compression related to tumor growth. Which patient statement is most likely to suggest an early manifestation? a. "Last night my back really hurt, I had trouble sleeping." b. "My leg has been giving out when I try to stand." c. "My bowels are just not moving like they usually do." d. "When I try to pass urine, I have difficulty starting the stream."

A

A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best? (Select all that apply.) a. Assess the daily serum calcium level. b. Consult the provider about a loop diuretic. c. Institute seizure precautions for the client. d. Instruct the client to call for help out of bed. e. Place the client on a 1500-mL fluid restriction.

A,B,D

The nurse is caring for a client with lung cancer and bone metastasis. What s/s would the nurse recognize as indications of a possible oncological emergency? Select all that apply a. Facial edema in the morning b. Weight loss of 20lb in 1 month c. Serum calcium of 12 d. Serum sodium of 136 e. Serum potassium of 3.4 f. Numbness and tingling of the lower extremities

A,C,F

A nurse observes shoulder drop postoperatively in a client who had a radical neck dissection for cancer 24 hours ago. What is the nurse's best action? A. Reposition the client on the nonoperative side. B. Document the observation as the only action. C. Assess deep tendon reflexes. D. Notify the physician.

B

A patient whose tracheostomy was inserted 30 minutes ago is recovering in the postanesthesia recovery unit when he coughs and expels the tracheostomy tube. How should the nurse respond? a. Suction the tracheostomy opening. b. Maintain the airway with a sterile hemostat. c. Use an Ambu bag and mask to ventilate the patient. d. Insert the tracheostomy tube obturator into the stoma.

B

For a patient with osteogenic sarcoma, which laboratory value causes you the most concern? a. Sodium level of 135 b. Calcium level of 13 c. Potassium level of 4.9 d. Hematocrit of 40%

B

In staging and grading neoplasm TNM system is used. TNM stands for: a. Time, neoplasm, mode of growth b. Tumor, node, metastasis c. Tumor, neoplasm, mode of growth d. Time, node, metastasis

B

The client who is scheduled to have a vertical laryngectomy asks a nurse what changes to expect in voice quality after the surgery. What is the nurse's best response? A. "You will not be able to speak above a whisper." B. "Your permanent voice will be hoarse and breathy." C. "The removal of your larynx results in permanent loss of natural speech." D. "Speech will be absent immediately following surgery but will return to normal when all swelling has resolved, usually within 6 months."

B

The majority of osteosarcomas occur in which age group? a. over 65 b. Pre-teens and adolescents c. Middle age d. Children under 10

B

When caring for a patient who is 3 hours postoperative laryngectomy, what is the nurse's highest priority assessment? a. Patient comfort b. Airway patency c. Incisional drainage d. Blood pressure and heart rate

B

Which conditions or factors in a 64-year-old man diagnosed with head and neck cancer are most likely to have contributed to this health problem? A. He quit school at age 16 and has worked in a butcher shop for over 40 years. B. He uses chewing tobacco and drinks beer daily. C. His father also had head and neck cancer. D. His hobby is oil painting.

B

Which intervention should the nurse use to help prevent a carotid artery rupture after radical neck dissection surgery? A. Applying direct pressure to the carotid artery B. Keeping the carotid artery and the dressing wet with sterile saline C. Maintaining the stability of the position of the laryngectomy tube D. Assessing the adequacy of blood flow with a Doppler every 2 hours

B

Which statement made by the client undergoing radiation treatment for laryngeal cancer indicates the need for continued discussion regarding the effects of therapy? A. "I will avoid exposing my skin to sunlight during treatment." B. "I will purchase a wig so that my appearance will be close to normal." C. "I will rest my voice and communicate by writing for the next two months." D. "I will not shave until all the redness and peeling of the skin on my face and neck is gone."

B

Which task can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) in the care of a stable patient who has a tracheostomy? a. Assessing the need for suctioning b. Suctioning the patient's oropharynx c. Assessing the patient's swallowing ability d. Maintaining appropriate cuff inflation pressure

B

When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply a. Limiting the time with the client to 1 hour per shift b. Keeping pregnant women out of the client's room c. Placing the client in a private room with a private bath d. Wearing a lead shield when providing direct client care e. Removing the dosimeter film badge when entering the client's room f. Allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client

B, C, D

A client has a metastatic bone tumor. What action by the nurse takes priority? a. Administer pain medication as prescribed. b. Elevate the extremity and apply moist heat. c. Handle the affected extremity with caution. d. Place the client on protective precautions.

C

A client is scheduled for a bone biopsy. What action by the nurse takes priority? a. Administering the preoperative medications b. Answering any questions about the procedure c. Ensuring that informed consent is on the chart d. Showing the clients family where to wait

C

A clinic nurses prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? a. "You can take aspirin as needed for headache" b. "You can drink beverages containing alcohol in moderate amounts each evening." c. "You need to consult your HCP before receiving immunizations." d. "It is fine to receive the flu vaccine at the local health fair without HCP approval because the flu is so contagious."

C

A hospitalized client is being treated for Ewings sarcoma. What action by the nurse is most important? a. Assessing and treating the client for pain as needed b. Educating the client on the disease and its treatment c. Handling and disposing of chemotherapeutic agents per policy d. Providing emotional support for the client and family

C

An athletic young man was recently diagnosed with Ewings sarcoma. He has pain, low-grade fever, and anemia. The surgeon recommends amputation of the right lower leg for an operable tumor. The patient tells you he is leaving the hospital to go on a long hiking trip. What is the priority nursing diagnosis? a. Acute pain related to tumor invasion of soft tissue b. Fatigue related to anemia c. Ineffective coping related to loss of body image d. Noncompliance related to personal values

C

For care of a patient who has oral cancer, which task would be appropriate to delegate to an LPN/LVN? a. Assisting the patient to brush and floss b. Explaining when brushing and flossing are contraindicated c. Giving antacids and sucralfate suspension as ordered d. Recommending saliva substitutes

C

For the patient receiving the chemotherapeutic drug Vincristine (Oncovin), which side effect should be reported to the physician? a. Fatigue b. Nausea and Vomiting c. Paresthesia d. Anorexia

C

For which client is esophageal speech communication after laryngectomy contraindicated? A. The client whose native language is not English B. The client with a permanent tracheostomy C. The client with a permanent hearing loss. D. The client who continues to smoke

C

Skin reactions are common in radiation therapy. Nursing responsibilities on promoting skin integrity should be promoted apart from: a. Avoiding the use of ointments, powders, and lotions to the area b. Using soft cotton fabrics c. Washing the area with mild soap and water and patting it dry not rubbing it d. Avoiding direct sunshine or cold

C

The client has experienced neck trauma from a car crash. The airway is patent and the client is hemodynamically stable. For what associated injury should the nurse be particularly alert? A. Hepatic laceration and hematoma B. Unilateral hemothorax C. Cervical spinal injury D. Crushed pelvis

C

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? a. Restrict all visitors b. Restrict fluid intake c. Teach the client and family about the need for hand hygiene d. Insert an indwelling urinary catheter to prevent skin breakdown

C

The patient has been diagnosed with head and neck cancer. Along with the treatment for the cancer, what other treatment should the nurse expect? a. Nasal packing b. Epistaxis balloon c. Gastrostomy tube d. Peripheral skin care

C

What health promotion activity should the nurse stress to the client who has xerostomia as a result of radiation therapy for head and neck cancer? A. Carrying a medical alert card B. Increasing carbohydrate and fat intake C. Having a dental examination twice per year D. Using only water-soluble lubricants on the irradiated skin

C

What is the priority nursing assessment in the care of a patient who has a tracheostomy? a. Electrolyte levels and daily weights b. Assessment of speech and swallowing c. Respiratory rate and oxygen saturation d. Pain assessment and assessment of mobility

C

Which clinical manifestation in a client who smokes two packs of cigarettes per day should be explored further for head and neck cancer? A. Unplanned weight gain of 15 pounds B. Decreased sense of taste C. Difficulty swallowing D. Persistent bad breath

C

Which of the following is benign, bone-forming tumor characterized by a small area of neoplastic growth surrounded by an area of mature, reactive bone? a. Fibrosarcoma b. Ewing's sarcoma c. Osteoid osteoma d. Osteosarcoma

C