Chapter 2 - Prioritization, Delegation, and Assignment
For a patient who is experiencing side effects of radiation therapy, which task would be the *most* appropriate to delegate to unlicensed assistive personnel (UAP)? •Helping the patient to identify patterns of fatigue •Recommending participation in a walking program •Reporting the amount and type of food consumed from the tray •Checking the skin for redness and irritation after the treatment
•Reporting the amount and type of food consumed from the tray •The UAP can observe the amount that the patient eats (or what is gone from the tray) and report to the nurse. Assessing patterns of fatigue and skin reaction is the responsibility of the RN. The initial recommendation for exercise should come from the health care provider.
In the care of a patient with neutropenia, what tasks should the nurse instruct unlicensed assistive personnel (UAP) to perform? *Select all that apply.* •Taking vital signs every 4 hours •Reporting temperature of more than 100.4°F (38°C) •Assessing for sore throat, cough, or burning with urination •Gathering the supplies to prepare the room for protective isolation •Reporting superinfections, such as candidiasis •Practicing good hand-washing technique
•Taking vital signs every 4 hours •Reporting temperature of more than 100.4°F (38°C) •Gathering the supplies to prepare the room for protective isolation •Practicing good hand-washing technique •Measuring vital signs and reporting on specific parameters, practicing good hand washing, and gathering equipment are within the scope of duties for a UAP. Assessing for symptoms of infections and superinfections is the responsibility of the RN.
For a patient who is receiving chemotherapy, which laboratory result is of particular importance? •White blood cell count •Prothrombin time •Electrolyte levels •Blood urea nitrogen level
•White blood cell count •The white blood cell count is especially important because chemotherapy can decrease white blood cells, particularly neutrophils (known as neutropenia). This leaves the patient vulnerable to infection. The other tests are important in the total management but are less directly specific to chemotherapy.
The nurse is caring for a patient with esophageal cancer. Which task could be delegated to unlicensed assistive personnel (UAP)? •Assisting the patient with oral hygiene •Observing the patient's response to feedings •Facilitating expression of grief or anxiety •Initiating daily weights
•Assisting the patient with oral hygiene •Oral hygiene is within the scope of duties of the UAP. It is the responsibility of the nurse to observe response to treatments and to help the patient deal with loss or anxiety. The UAP can be directed to weigh the patient but should not be expected to know when to initiate that measurement.
After chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory result requires particular attention? •Platelet counts •Electrolyte levels •Hemoglobin levels •Hematocrit levels
•Electrolyte levels •Tumor lysis syndrome can result in severe electrolyte imbalances and potential kidney failure. The other laboratory values are important to monitor to identify general chemotherapy side effects but are less pertinent to tumor lysis syndrome.
The patient describes a burning sensation in the leg. The health care provider tells the nurse that a medication will be prescribed for neuropathic pain secondary to chemotherapy. The nurse is *most* likely to question the prescription of which drug? •Imipramine •Carbamazepine •Gabapentin •Morphine
•Morphine •Morphine is usually not prescribed for neuropathic pain because pain relief response is poor. Other medications, some antidepressants (e.g., imipramine) and some anticonvulsants (e.g., carbamazepine and gabapentin), provide better relief.
An older patient needs treatment and relief for severe localized pain related to postherpetic neuralgia that developed during chemotherapy. The nurse is *most* likely to question the prescription of which type of medication? •Lidocaine patch •Gabapentinoid •Capsaicin patch •Tricyclic antidepressant
•Tricyclic antidepressant •Age, malignancy, immunocompromised conditions (e.g., human immunodeficiency virus), and immunosuppressive medications increase the risk for herpes zoster. Lidocaine patches, gabapentinoids (e.g., gabapentin), and tricyclic antidepressants (e.g., imipramine) are first-line choices for postherpetic neuralgia, which can be a long-term sequela to herpes zoster. However, the American Geriatrics Society recommends that tricyclics should be avoided for older adults because of side effects, such as confusion or orthostatic hypotension. Capsaicin patches are considered a second-line option. A lidocaine patch would be a good choice for this patient because it can be applied to the local area with limited systemic effects.
Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? *Select all that apply.* •Provide mouthwash with alcohol for oral rinsing •Use paper tape on fragile skin •Provide a soft toothbrush or oral sponge •Gently insert rectal suppositories •Avoid aspirin or aspirin-containing products •Avoid overinflation of blood pressure cuffs
•Use paper tape on fragile skin •Provide a soft toothbrush or oral sponge •Avoid aspirin or aspirin-containing products •Avoid overinflation of blood pressure cuffs •Mouthwash should not include alcohol because it has a drying action that leaves the mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or vaginal cavity is not recommended. All other options are appropriate.
A patient who has cancer will need ongoing treatment for pain. Which brochure is the nurse most likely to prepare that addresses questions related to the first-line treatment of cancer pain? •"An Illustrated Guide to the Analgesic Ladder" •"Common Questions About Radiation Therapy" •"How to Make Preparations for Your Cancer Surgery" •"How Nerve Blocks Can Help to Manage Cancer Pain"
•"An Illustrated Guide to the Analgesic Ladder" •Analgesic drugs are the first-line treatment for cancer pain management. If pain is not controlled by medication, other options are available, including radiation, surgery, and nerve blocks.
The night shift nurse tells the oncoming dayshift nurse that the cancer patient is on around-the-clock dosing of morphine but that the patient might be having end-of-dose pain. Which question is the *most* important to ask the night shift nurse? •"How many times did you have to give a bolus dose of morphine?" •"Did the patient tell you that the pain was greater than a 5/10?" •"Did you notify the health care provider (HCP), and were changes prescribed?" •"Did you try any nonpharmaceutical therapies or adjuvant medications?"
•"Did you notify the health care provider (HCP), and were changes prescribed?" •The nurse might ask any of these questions, but the most important question is whether the HCP was notified and if any changes were made to address the patient's pain. If the HCP was not called during the night (which is often the case), then the day shift nurse must assess the patient's current pain, talk to him or her directly about last night's pain, and gather data about the frequency of bolus doses and other options that were tried. Data about last night's care should be available in the patient's record if it is not mentioned in report.
The home health nurse is reviewing the cancer patient's medication list and sees that a bisphosphonate medication has been prescribed. Which question is the nurse *most* likely to ask to evaluate the efficacy of the medication? •"Has the medication helped relieve the discomfort in your mouth?" •"Have you noticed any increase or changes in your energy level?" •"Has the medication helped to stop the nausea and vomiting?" •"Has the medication relieved the bone pain that you were having?"
•"Has the medication relieved the bone pain that you were having?" •Bisphosphonate medications are used for patients with cancer help to relieve bone pain associated with primary bone cancer or metastasis and to reduce the risk of fractures. They also lower the calcium level in the blood.
The nurse is monitoring a patient who is at risk for spinal cord compression related to tumor growth. Which patient statement is *most* likely to suggest an *early* manifestation? •"Last night my back really hurt, and I had trouble sleeping." •"My leg has been giving out when I try to stand." •"My bowels are just not moving like they usually do." •"When I try to pass urine, I have difficulty starting the stream."
•"Last night my back really hurt, and I had trouble sleeping." •Back pain is an early sign of spinal cord compression occurring in 95% of patients. The other symptoms are later signs.
The healthcare provider (HCP) tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement is cause for *greatest* concern? •"My symptoms will eventually be cured; I'm so happy that I don't have to worry any longer." •"My doctor is trying to help me control the symptoms; I am grateful for the extension of time with my family." •"My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death." •"Initially, I may have to take some time off work for my treatments; I can probably work full time in the future."
•"My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death." •The nurse should assess what the patient means by having "control over my own life and death." This could be an indirect statement of suicidal intent. A patient who believes he will be cured should also be assessed for misunderstanding what the HCP said; however, the patient may need to use denial as a temporary defense mechanism. Acknowledgment that the treatments are for control of symptoms and plans for the immediate future suggest an understanding of what the HCP said.
The nurse is interviewing a patient who was treated several months ago for breast cancer. The patient reports taking nonsteroidal anti-inflammatory drugs (NSAIDs) for back pain. Which patient comment is cause for *greatest* concern? •"The NSAIDs are really not relieving the back pain." •"The NSAID tablets are too large, and they are hard to swallow." •"I gained weight because I eat a lot before taking NSAIDs." •"The NSAIDs are upsetting my stomach in the morning."
•"The NSAIDs are really not relieving the back pain." •Primary cancers (lung, prostate, breast, and colon) may metastasize to the spine. In spinal cord compression, back pain is a common early symptom. Later symptoms include weakness, loss of sensation, urinary retention or incontinence, and constipation.
The nurse hears in hand-off report that the patient with cancer received an as needed (PRN) oral dose of lorazepam. Which question is the oncoming nurse *most* likely to ask the off-going nurse in relation to the medication? •"What did the patient say about the location and level of the pain?" •"Were you able to determine what was making the patient so anxious?" •"When is the patient allowed to have another dose of lorazepam?" •"Did the patient have a normal bowel movement after the medication?
•"Were you able to determine what was making the patient so anxious?" •Lorazepam is a benzodiazepine, and it is not a first-line drug for cancer pain. It can be used for anxiety, insomnia, alcohol withdrawal, and muscle spasms and may be used in combination with other antiemetics for cancer-induced nausea and vomiting. If the trigger factors for anxiety are identified, the nursing staff can plan nonpharmaceutical interventions.
The day shift nurse is assessing the patient who has breast cancer and notices edema of the face, periorbital edema, and tightness around the neck of the gown. The nurse immediately notifies the health care provider for early signs and symptoms of superior vena cava syndrome. From the figure identify the superior vena cava. •A (pointing to the major vein carrying blood from the upper portion of the body) •B (pointing to the major artery taking blood to the upper portion of the body) •C (pointing to the artery taking blood to the lower portion of the body)
•A (pointing to the major vein carrying blood from the upper portion of the body) •The superior vena cava returns blood from the head, neck, and upper extremities to the heart. Compression or obstruction of the vessel leads to congestion of the blood, which causes the early manifestation of edema in the face. This is more noticeable when the patient is in a supine position. Edema of the upper body can progress. Stridor caused by narrowing of the pharynx or larynx is an ominous sign. Late symptoms include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension.
People at risk are the target populations for cancer screening programs. According to the latest screening recommendations from the American Cancer Society, which of these asymptomatic patients need extra encouragement to participate in cancer screening? *Select all that apply.* •A 21-year-old white American woman who is sexually inactive, for a Pap test •A 30-year-old Asian-American woman, for an annual mammogram •A 45-year-old African-American man, to talk with health care provider about prostate cancer •A 50-year-old white American man, for a fecal occult blood test •A 50-year-old white American woman, for a colonoscopy •A 70-year-old Asian-American woman who had a total hysterectomy 15 years ago (not for cancer reasons), for a Pap test
•A 21-year-old white American woman who is sexually inactive, for a Pap test •A 45-year-old African-American man, to talk with health care provider about prostate cancer •A 50-year-old white American man, for a fecal occult blood test •A 50-year-old white American woman, for a colonoscopy •At 21 years of age, women should have a Pap smear, regardless of sexual activity. African-American men starting at age 45 years should talk to their health care providers about prostate cancer and risk versus benefits of prostate-specific antigen testing. Colonoscopy and annual fecal occult blood testing are recommended for those with average risk starting at age 50 years. Annual mammograms are recommended for women at the age of 45 to 54 years. (See answer 40 for additional information about breast cancer screening.) Women who have had a total hysterectomy for reasons other than cancer do not need a Pap test.
The oncoming day shift nurse has just received hand over report from the night shift nurse. List the order of priority for assessing and caring for the following patients, with 1 being first and 4 being last. •A patient who developed tumor lysis syndrome around 5:00 am •A patient who is currently pain free but had breakthrough pain during the night •A patient scheduled for exploratory laparotomy this morning •A patient with anticipatory nausea and vomiting for the past 24 hours
•A patient who developed tumor lysis syndrome around 5:00 am •A patient scheduled for exploratory laparotomy this morning •A patient who is currently pain free but had breakthrough pain during the night •A patient with anticipatory nausea and vomiting for the past 24 hours •Tumor lysis syndrome is an emergency involving electrolyte imbalances and potential renal failure. A patient scheduled for surgery should be assessed before leaving the unit, and any final preparations for surgery should be completed. A patient with breakthrough pain needs a thorough pain assessment, an investigation of pain patterns, and a chart review of all attempted pharmaceutical and nonpharmaceutical interventions; the health care provider may need to be contacted for a change of dosage or medication. Anticipatory nausea and vomiting has a psychogenic component that requires assessment, teaching, reassurance, and administration of antiemetics.
When care assignments are being made for patients with alterations related to gastrointestinal (GI) cancer, which patient would be the *most* appropriate to assign to an LPN/LVN under the supervision of a team leader RN? •A patient with severe anemia secondary to GI bleeding •A patient who needs enemas and antibiotics to control GI bacteria •A patient who needs preoperative teaching for bowel resection surgery •A patient who needs central line insertion for chemotherapy
•A patient who needs enemas and antibiotics to control GI bacteria •Administering enemas and antibiotics is within the scope of practice of LPNs/LVNs. Although some states and facilities may allow the LPN/LVN to administer blood, in general, administering blood, providing preoperative teaching, and assisting with central line insertion are the responsibilities of the RN.
Which cancer patients could be placed together as roommates? *Select all that apply.* •A patient who has a very low neutrophil count •A patient who underwent debulking of a tumor to relieve pressure •A patient who just underwent a bone marrow transplantation •A patient who had a laminectomy for spinal cord compression •A patient who is undergoing brachytherapy for prostate cancer •A patient with terminal cancer who is receiving end-of-life care
•A patient who underwent debulking of a tumor to relieve pressure •A patient who had a laminectomy for spinal cord compression •Debulking of tumor and laminectomy are palliative procedures. These patients can be placed in the same room. The patient with a low neutrophil count and the patient who had a recent bone marrow transplantation need protective isolation. The patient who is undergoing brachytherapy needs a private room because radiation is being emitted while the implant is in place. The patient with terminal cancer needs comfort measures, such as privacy, family members at the bedside, and symptom relief. In addition, observing a roommate who has end-of-life symptoms could be very stressful for another patient.
The nurse is providing end-of-life-care for a patient with terminal liver cancer. The patient is weak and restless. Her skin is cool and mottled. Dyspnea develops, and the patient appears anxious and frightened. What should the nurse do *first*? •Administer an as needed (PRN) dose of morphine elixir •Alert the Rapid Response Team and call the health care provider •Deliver breaths at 20 breaths/min with a bag-valve mask and prepare for intubation •Sit quietly with the patient and offer emotional support and comfort
•Administer an as needed (PRN) dose of morphine elixir •Morphine elixir is the therapy of choice because it is thought to reduce anxiety and the subjective sensation of air hunger. It also increases venous capacitance. End-of-life care should not include aggressive measures such as intubation or resuscitation. Support and comfort are always welcome, but in this case, there is an option that would offer some physical relief for the patient.
When staff assignments are made for the care of patients who are receiving chemotherapy, what is the *major* consideration regarding chemotherapeutic drugs? •Administration of chemotherapy requires precautions to protect self and others •Many chemotherapeutic drugs are vesicants •Chemotherapeutic drugs are frequently given through central venous access devices •Oral and venous routes of administration are the most common
•Administration of chemotherapy requires precautions to protect self and others •Chemotherapy drugs should be given by nurses who have received additional training in how to safely prepare and deliver the drugs and protect themselves and others from exposure. The other options are relevant, but the general principles of drug administration apply.
Which patient is at *greatest* risk for pancreatic cancer? •An older African-American man who smokes •A young white obese woman with gallbladder disease •A young African-American man with type 1 diabetes •An elderly white woman who has pancreatitis
•An older African-American man who smokes •Pancreatic cancer is more common in African Americans, men, and smokers. Other associated factors include older age, alcohol use, diabetes, obesity, history of pancreatitis, exposure to organic chemicals, consumption of a high-fat diet, and previous abdominal irradiation.
A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While the nurse is trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the *priority* nursing concept to consider in responding to this patient? •Elimination •Patient education •Cellular regulation •Anxiety
•Anxiety •The patient's physical condition is currently stable, but emotional needs are affecting his or her ability to receive the information required to make an informed decision. The other concepts are relevant, but if the patient leaves the clinic, the interventions may be delayed or ignored.
The charge nurse discovers that two nurses have switched patients because Nurse A does "not like to take care of patients with prostate cancer." Which action should the charge nurse take *first*? •Insist that they switch back to the original patient assignments and talk to each of them at the end of the shift •Allow them this flexibility; as long as the patients are well cared for, it doesn't matter if the assignments are changed •Ask Nurse A to explain her position regarding prostate cancer patients and seek alternatives to prevent future issues •Explain to Nurse A and B that all patients deserve kindness and care regardless of their condition or the nurses' personal feelings
•Ask Nurse A to explain her position regarding prostate cancer patients and seek alternatives to prevent future issues •First, the charge nurse must try to find out what Nurse A is thinking and feeling. After the underlying issue is discovered, a plan can be made to assist her (e.g., referral to counseling or in-service training). The charge nurse should try to avoid being too draconian with the staff by insisting that they switch back to the original assignments or too condescending by lecturing them about patients' rights. Nurses frequently can and do switch patients to help each other out, but the charge nurse should always be informed before making the switch.
The nurse is caring for a patient with uterine cancer who is being treated with intracavitary radiation therapy. Unlicensed assistive personnel (UAP) reports that the patient insisted on ambulating to the bathroom and now "something feels like it is coming out." What is the *priority* action? •Assess the UAP's knowledge; explain the rationale for strict bed rest •Assess for dislodgment; use forceps to retrieve and a lead container to store as needed •Assess the patient's knowledge of the treatment plan and her willingness to participate •Notify the health care provider about dislodgment of the radiation implant
•Assess for dislodgment; use forceps to retrieve and a lead container to store as needed •If the radiation implant has obviously been expelled (e.g., is on the bed linens), use a pair of forceps to place the radiation source in a lead container. The other options would be appropriate after safety of the patient and personnel are ensured.
For a patient with osteogenic sarcoma, which laboratory value causes the *most* concern? •Sodium level of 135 mEq/L (135 mmol/L) •Calcium level of 13 mg/dL (3.25 mmol/L) •Potassium level of 4.9 mEq/L (4.9 mmol/L) •Hematocrit of 40%
•Calcium level of 13 mg/dL (3.25 mmol/L) •The normal range for calcium is 9.0 to 10.5 mg/dL (2.25 to 2.75 mmol/L). Potentially life-threatening hypercalcemia can occur in cancers with destruction of bone. Other laboratory values are pertinent for overall patient management but are less specific to bone cancers.
The nurse is caring for an older woman with hepatic cancer. Unlicensed assistive personnel informs the nurse that the patient's level of consciousness is diminished compared with earlier in the shift. Prioritize the steps of assessment and intervention related to this patient's change of mental status. •Take vital signs, including pulse, respirations, blood pressure, and temperature •Check responsiveness and level of consciousness •Obtain a blood glucose reading; give glucose per protocol •Check electrolyte values •Check ammonia levels •Check pulse oximeter readings and administer oxygen as needed
•Check responsiveness and level of consciousness •Check pulse oximeter readings and administer oxygen as needed •Take vital signs, including pulse, respirations, blood pressure, and temperature •Obtain a blood glucose reading; give glucose per protocol •Check electrolyte values •Check ammonia levels •Determine level of consciousness and responsiveness along with changes from baseline. Oxygen should be administered immediately in the presence of respiratory distress or risk for decreased oxygenation and perfusion. Pulse oximetry can be used for continuous monitoring. Adequate pulse, blood pressure, and respirations are required for cerebral perfusion. Increased temperature may signal infection or sepsis. Blood glucose levels should be checked even if the patient does not have diabetes. Severe hypoglycemia should be immediately treated per protocol. Electrolyte and ammonia levels are relevant data for this patient, and abnormalities in these parameters may be contributing to change in mental status. (*Note*: Laboratory results [i.e., electrolytes and ammonia levels] may be concurrently available; however, the nurse should systematically look at data. Look at electrolytes first because these are more commonly ordered. The nurse may have to remind the health care provider to order the ammonia level if the patient with a hepatic disorder is having a change in mental status.)
The nurse is asked to float to a different nursing unit. During report, the nurse is told that the patient is receiving IV administration of vincristine that should be completed within the next 15 minutes. The IV site is intact, and the patient is not having any problems with the infusion. The nurse is not certified in chemotherapy administration. What is the *priority* action? •Ask the off-going nurse to stay until the vincristine infusion is finished •Ask the off-going nurse about problems to expect with vincristine infusions •Contact the charge nurse and discuss the lack of chemotherapy certification •Look up drug side effects and monitor because the infusion is almost complete
•Contact the charge nurse and discuss the lack of chemotherapy certification •Contact the charge nurse about the patient assignment. All nurses can assess patients, IV sites, and infusions; however, chemotherapy medications require special expertise. Asking the nurse to stay is not the best solution because the care of the patient and the effects of the medication continue after the infusion has been completed. Asking about or looking up the side effects of the drug is okay for personal information, but lack of chemotherapy certification is still an issue. In addition, knowing how to properly discontinue the infusion and dispose of the equipment are essential for personal safety and the safety of others. (*Note to students:* Facility policies may vary regarding chemotherapy certification. In your future career, for your safety and the safety of your patients, find out what the facility policy is and pursue certification as needed.)
An athletic young man was recently diagnosed with Ewing 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 the nurse that he is leaving the hospital to go on a long hiking trip. What is the *priority* nursing concept to consider at this time? •Pain •Cellular regulation •Coping •Adherence
•Coping •The patient is not coping with the recent diagnosis of cancer and prospect of losing his leg. His decision to go hiking may be a form of denial or possibly a veiled suicide threat. It is also possible that he has decided not to have any treatment; however, the nurse needs to make additional assessment about his decision and actions and help him to discuss alternatives and consequences. This situation is complex, but if he leaves the hospital, there may be no chance to address any other issues.
Which assessment finding strongly suggests that the patient with cancer is having incident pain? •Frequently reports pain about 30 to 35 minutes before next scheduled dose •Demonstrates protectiveness of right arm whenever moving or standing up •Reports a continuous burning and tingling sensation in left lower leg •Appears quiet, withdrawn and depressed when family leaves after visiting
•Demonstrates protectiveness of right arm whenever moving or standing up •Incident pain is pain that is associated with an event, such as walking, position change, or coughing. In this case, movement is the incident that causes pain and the patient's reaction to protect the arm. Pain 30 to 45 minutes before the next scheduled dose is breakout pain. Burning and tingling are descriptors of neuropathic pain. Depression and withdrawal could occur with all types of pain, especially severe chronic pain. When friends and family are not available, the nurse could try other forms of distraction.
An experienced nurse is precepting a newly hired nurse who has 2 years of medical-surgical experience but limited experience with patients who have cancer. The new hire seems to be consistently under medicating the patients' pain. What should the preceptor do *first*? •Reassess all of the patients and administer additional pain medication as needed •Write an incident report and inform the nurse manager about the nurse's performance •Determine the new nurse's understanding and beliefs about cancer pain and treatments •Ask the new nurse about past experience in administering pain medications
•Determine the new nurse's understanding and beliefs about cancer pain and treatments •First, the preceptor assesses the newly hired nurse's knowledge and beliefs about cancer pain and treatment. The nurse has experience, but that past experience may be related to caring for patients with acute pain, such as postoperative or acute exacerbations of disease. After assessing knowledge, the preceptor can then correct misconceptions or make suggestions for further study. Reassessing the patients together could be a learning opportunity. Writing an incident report and going to the nurse manager might occur if the new nurse is unable to adapt and correct behavior.
A primary nursing responsibility is the prevention of lung cancer by assisting patients in cessation of smoking or other tobacco use. Which task would be appropriate to assign to an LPN/LVN? •Develop a "quit plan" •Explain how to apply a nicotine patch •Discuss strategies to avoid relapse •Suggest ways to deal with urges for tobacco
•Explain how to apply a nicotine patch •An LPN/LVN is versed in medication administration and able to teach patients standardized information. The other options require more in-depth assessment, planning, and teaching, which should be performed by the RN. Helping patients with smoking cessation is a Core Measure.
A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone secretion (SIADH). After reporting symptoms of weight gain, weakness, and nausea and vomiting to the health care provider, the nurse would anticipate which *initial* treatment for this patient? •A fluid bolus •Fluid restrictions •Urinalysis •Sodium-restricted diet
•Fluid restrictions •Hyponatremia is a concern; therefore, fluid restrictions would be prescribed. Urinalysis is less pertinent; however, the nurse should monitor for changes in urine specific gravity. The diet may need to include sodium supplements. Fluid bolus is unlikely for patients with SIADH; however, IV normal saline or hypertonic saline solutions may be given very cautiously.
The nurse is talking to a group of older women about breast cancer. Based on the most recent guidelines from the American Cancer Society and the American Society of Clinical Oncology, what will the nurse tell the group about the current recommendations for breast cancer screening? •For older women in good general health and a life expectancy of 10 or more years, biennial or annual mammography screening is recommended •For women older than the age of 55 years with average risk for breast cancer, mammography screening is recommended every 3 to 5 years •For women older than the age of 70 with average risk for breast cancer, annual screening mammography is not recommended •Starting at age 40 years, all women with average risk for breast cancer should have annual clinical breast examination and mammography screening
•For older women in good general health and a life expectancy of 10 or more years, biennial or annual mammography screening is recommended •Recent guidelines from the American Cancer Society and the American Society of Clinical Oncology include specific recommendations for screening based on age include the following: -Between ages 40 and 44 years, women can be offered annual screenings -Starting at age 45 years, for women of average risk for breast cancer, regular screening mammography is recommended -For women 45 to 54 years, annual screening mammography is recommended -For women 55 years and older, either biennial screening or continuing annual screenings may be appropriate -At any age, as long as they are in good general health and have a life expectancy of at least 10 years, older women should continue screening mammography -At any age, average-risk women should not undergo a clinical breast examination for breast cancer screening
For care of a patient who has oral cancer, which task would be appropriate to assign to an LPN/LVN? •Assisting the patient to perform oral hygiene •Explaining when brushing and flossing are contraindicated •Giving antacids and sucralfate suspension as ordered •Recommending saliva substitutes
•Giving antacids and sucralfate suspension as ordered •Giving medications is within the scope of practice of the LPN/LVN. Assisting the patient with oral hygiene should be delegated to unlicensed assistive personnel, but the nurse should give specific instructions related to the condition of the patient's mouth. Explaining contraindications is the responsibility of the RN. Recommendations for saliva substitutes should come from the health care provider or pharmacist.
The nurse assesses the patient and determines that the patient is having frequent breakthrough cancer pain. Which member of the health care team is the nurse most likely to contact *first*? •Physical therapist to reevaluate physical therapy routines •Health care provider to review medication, dosage, and frequency •Unlicensed assistive personnel to provide more assistance with activities of daily living •Psychiatric clinical nurse specialist to evaluate psychogenic pain
•Health care provider to review medication, dosage, and frequency •Breakthrough pain is defined as rapid onset, short duration, and moderate to severe; a temporary exacerbation related to poorly controlled around-the-clock dosing of background pain. Frequent breakthrough pain suggests that the around-the-clock dosing needs reevaluation, so the nurse would contact the health care provider and advocate for a change of medication or dose or frequency.
Which nurse is demonstrating the *first* step in managing cancer pain by using the ABCDE (ask, believe, choose, deliver, and empower) clinical approach to pain management as recommended by the Agency for Healthcare Research and Quality? •Nurse J asks if the time of the prescribed dose of medication can be changed •Nurse K asks the patient to describe pain and uses a numerical pain scale •Nurse L asks the patient to participate and to contribute in pain management •Nurse M asks about pain management options that are appropriate for the patient
•Nurse K asks the patient to describe pain and uses a numerical pain scale •Asking the patient to describe the pain is the first step. The ABCDE step-by-step clinical approach includes ask, believe, choose, deliver, and empower (or enable).
For a patient receiving the chemotherapeutic drug vincristine, which side effect should be reported to the healthcare provider (HCP)? •Fatigue •Nausea •Paresthesia •Anorexia
•Paresthesia •Paresthesia is a side effect associated with some chemotherapy drugs such as vincristine. The HCP can modify the dosage or discontinue the drug. Fatigue, nausea, vomiting, and anorexia are common side effects of many chemotherapy medications. The nurse can assist the patient by planning for rest periods, giving antiemetics as ordered, and encouraging small meals containing high-protein and high-calorie foods.
A community health center is preparing a presentation on the prevention and detection of cancer. Which task would be *best* to assign to the LPN/LVN? •Explain screening examinations and diagnostic testing for common cancers •Discuss how to plan a balanced diet and reduce fats and preservatives •Prepare a poster on the seven warning signs of cancer •Describe strategies for reducing risk factors such as smoking and obesity
•Prepare a poster on the seven warning signs of cancer •The LPN/LVN will know the standard seven warning signs and can educate through standard teaching programs. The health care provider performs the physical examinations and recommends diagnostic testing. The nutritionist can give information about diet. The RN has primary responsibility for educating people about risk factors.
