CH 15 Cancer
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse indicates a need for further teaching?
the patient's visitors bring in fresh peaches - risk of bacteria being present
The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?
a 24-year old patient who received neck radiation and has blood oozing from the neck - the neck bleeding may indicate a possible carotid artery rupture in a patient who is receiving radiation to the neck.
The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment?
"I rarely have the energy to get out of bed" - fatigue can be a dose-limiting toxicity for use of immunotherapy.
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider?
increased carcinoembryonic antigen (CEA) - an increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified
The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider?
serum sodium of 126 mEq/L - SIADH and hyponatremia is an oncologic metabolic emergency and requires rapid treatment to prevent complications such as seizures and coma.
The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information?
"Can you tell me what has been helpful when coping with past stressful events?"
A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective?
"I can buy some aloe vera gel to use on my skin" - aloe vera gel and cream may be used on the radiated skin area.
A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is accurate?
"Malignant tumors may spread to other tissues or organs" - the major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors do not metastasize.
The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement by the patient indicates that teaching was effective?
"The biopsy will help decide the treatment for my enlarged prostate" - a biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed.
A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate?
"The cancer involves only the cervix" - cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time.
A widowed mother of 4 school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate?
"Would you like to talk about options for the care of your children?"
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?
Assess for sensation and strength in the legs - spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space
A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. What should the nurse teach the patient about the outcome of this procedure?
Decreasing the tumor size will improve the effects of other therapy - A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective
External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation?
Clean the perianal area carefully after every bowel movement - radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea.
A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband tells the nurse that he does not know what to say to his wife. Which problem is appropriate for the nurse to address in the plan of care?
Difficulty coping
A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient's self-esteem?
Encourage the patient to purchase a wig or hat to wear when hair loss begins
The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?
Hematuria - the adverse effects of intravascular chemotherapy are confined to the bladder.
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). Which information should the nurse include in the patient's teaching plan?
Hospitalization is required for several weeks after the stem cell transplant - the patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient?
IL-2 enhances the body's immunologic response to tumor cells - enhances the ability of the patient's own immune response to suppress tumor cells.
During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next?
Obtain more information about the patient's relatives - the patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment.
An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider?
Patient has crackles up to the midline posterior chest - rapid fluid infusions may cause heart failure, especially in older patients.
After change-of-shift report on the oncology unit, which patient should the nurse assess first?
Patient who is neutropenic and has a temperature of 100.5 F - fever is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis.
The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?
Stop the infusion if swelling is observed at the site - swelling at the site may indicate extravasation, and the IV should be stopped immeadiately.
When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?
The UAP assists the patient to use dental floss after eating - use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding
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?
The UAP stands by the patient's bed for 30 minutes talking with the patient - because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited
A patient who has severe pain with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching about pain management has been effective?
The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs - for chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain
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?
White blood cells (WBC) 2700 - 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.
A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care?
establish time to take a short walk almost every day - walking programs are used to keep the patient active without excessive fatigue.
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?
"I will need follow-up examinations for many years after treatment before I can be considered cured." - the risk of recurrence varies by the type of cancer.
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.) Cook food thoroughly before eating. Choose low fiber, low residue foods. Avoid public transportation such as buses. Use rectal suppositories if needed for constipation. Talk to the oncologist before having any dental work.
1.Cook food thoroughly before eating. 2.Avoid public transportation such as buses. 3.Talk to the oncologist before having any dental work.
The nurse teaches a patient with liver cancer about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective?
Blueberry yogurt
The nurse should suggest which food choice for a patient scheduled to receive external-beam radiation for abdominal cancer?
baked chicken - protein is needed for wound healing. To minimize the diarrhea that is associated with bowel ration, the patient should avoid foods high in roughage, such as fruits and whole grains.
The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider?
crackles at the lung bases - capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2.
A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate?
Administer prescribed antiemetics 1 hour before the treatments
The nurse is caring for a patient who smokes 2 packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer?
Discuss risks associated with cigarettes during each patient encounter - teaching about risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems
The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse?
shortness of breath - Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration.
Which action should the nurse take when caring for a patient who is receiving chemotherapy and reports problems with concentration?
suggest use of a daily planner and encourage adequate sleep - use of tools to enhance memory and concentration such as a daily planner and adequate rest
The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (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.) Pap testing Tobacco use Sunscreen use Mammography Colorectal screening
1.Pap testing 2.Suncreen use 3.Mammography 4. Colorectal screening
During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which patient problem should the nurse identify?
Anxiety
A patient has inadequate nutrition due to painful oral ulcers. Which nursing action will be most effective in improving oral intake?
Apply prescribed anesthetic gel to oral lesions before meals
A patient with cancer is eating very little due to altered taste sensation. Which nursing action would address the cause of the patient problem?
Avoid giving the patient foods that are strongly disliked
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?
Rinse the mouth before and after each meal and at bedtime with a saline solution - should do this frequently
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?
the patient swims several days each week - the patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period.