Evolve final quiz

A client is admitted with a diagnosis of stage 0 cervical cancer (carcinoma in situ). What does the nurse emphasize while helping the client understand her diagnosis and prognosis? 1 Five-year survival rates for this cancer are nearly 100% with early treatment. 2 Radiation therapy is as successful as surgery in the treatment of this type of cancer. 3 Cancer has probably extended into the vaginal wall and may require a radical hysterectomy. 4 Stage 0 indicates that the cancer is invasive and may require surgery in addition to radiation therapy.

1 Five-year survival rates for this cancer are nearly 100% with early treatment. With carcinoma in situ the epithelium is eroded and replaced by rapidly dividing neoplastic cells. There is no distinct tumor; with treatment the prognosis is excellent. Preinvasive lesions of the cervix are treated with cryotherapy, laser therapy, or loop electrosurgical excision procedure, also known as LEEP. Radiation therapy is used for invasive cervical cancer. Stage II involves the vaginal wall; stage 0 is preinvasive. Stages I to IV are considered invasive by increasing degrees; stage 0 is preinvasive. Treatment is based on the staging.

A client who has been battling cancer of the ovary for 7 years is admitted to the hospital in a debilitated state. The healthcare provider tells the client that she is too frail for surgery or further chemotherapy. When making rounds during the night, the nurse enters the client's room and finds her crying. Which is the most appropriate intervention by the nurse? 1 Sit down quietly next to the bed and allow her to cry. 2 Pull the curtain and leave the room to provide privacy for the client. 3 Explain to the client that her feelings are expected and they will pass with time. 4 Observe the length of time the client cries and document her difficulty accepting her impending death

1 Sit down quietly next to the bed and allow her to cry. Sitting down quietly next to the bed and allowing her to cry demonstrates acceptance of the client's behavior and provides an opportunity for the client to verbally express feelings if desired. Pulling the curtain and leaving the room to provide privacy for the client may make the client feel that the behavior is wrong or is annoying others. Also, it abandons the client when support is needed. Explaining to the client that her feelings are expected and they will pass with time closes off communication and does not provide an opportunity for the client to talk about feelings. Also, it provides false reassurance. The length of time she cries is unimportant at this time. Assuming that she is having difficulty accepting her impending death is a conclusion without enough information.

After a client undergoes a biopsy for suspected cervical cancer, the laboratory report reveals a stage 0 lesion. What does a nurse conclude about this client's stage of cancer? 1 The lesion is carcinoma in situ. 2 There is early stromal invasion. 3 There is parametrial involvement. 4 The cancer is confined to the cervix

1 The lesion is carcinoma in situ According to the International Federation of Gynecology and Obstetrics, stage 0 is indicative of preinvasive cancer. When cancerous cells are completely confined within the epithelium of the cervix without stromal invasion, it is deemed stage 0 and called carcinoma in situ. Early stromal invasion is stage IA; there is minimal stromal invasion. Parametrial involvement, stage II, involves the area around the broad ligaments but not the pelvic wall; there is extension to the corpus of the uterus. Cancer confined to the cervix is classified as stage I.

An isolated older adult is diagnosed with cancer and fears death. Which intervention provided would help to induce relaxation and to communicate interest in the client? 1 Touch 2 Reminiscence 3 Reality orientation 4 Therapeutic communication

1 Touch Touch is a therapeutic tool that helps induce relaxation, provide physical and emotional comfort, and communicate interest in an older adult. Reminiscence helps to bring meaning and understanding to the patient's present situation and resolves current conflicts by recollecting the past. Reality orientation involves making an older adult more aware of time, place, and person. Therapeutic communication helps to perceive and respect the older adult's healthcare expectations.

An adolescent who is undergoing chemotherapy for the treatment of bone cancer has stomatitis as a result of chemotherapy. What should the nurse include when teaching the child about self-care? Select all that apply. 1 Clean the teeth with a swab. 2 Drink fluids through a straw. 3 Brush the teeth three times a day. 4 Rinse frequently with a mouthwash. 5 Avoid foods served at extremes of temperature.

1, 2, 5 A soft-tipped applicator should be used to help prevent trauma to the oral mucosa. Drinking fluids through a straw allows the fluid to bypass the sores in the mouth and may be less irritating to the mucosa; it provides comfort. Extremes in temperature may injure the oral mucosa and cause discomfort. Brushing the teeth three times a day will injure the oral mucosa and should be avoided. Rinsing frequently with a mouthwash may irritate the oral mucosa and should be avoided; if mouthwash is prescribed, it should be diluted.

For which side effects should a nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. 1 Diarrhea 2 Leukocytosis 3 Bleeding tendencies 4 Lowered sedimentation rate 5 Increased hemoglobin levels

1, 3 Most chemotherapeutic agents interfere with mitosis. The rapidly dividing cells of the mucous membranes of the gastrointestinal tract are affected, causing stomatitis and diarrhea. Bone marrow depression often causes thrombocytopenia, resulting in bleeding tendencies. The bone marrow consists of rapidly dividing cells, and therefore its activity is depressed. Leukopenia, not leukocytosis, can occur. The erythrocyte sedimentation rate generally increases in the presence of tissue inflammation or necrosis. Hemoglobin and hematocrit levels may decrease because of an inadequate number of red blood cells related to bone marrow depression.

67.What should a nurse include in the discharge instructions for a woman who has undergone breast-conserving surgery (lumpectomy) for breast cancer? 1 Assuring her that a supportive brassiere is unnecessary 2 Emphasizing the importance of breast self-examination 3 Instructing her to return the next day for removal of the drain 4 Explaining why it is unnecessary to exercise the arm on the unaffected side

2 Emphasizing the importance of breast self-examination A client who has cancer of one breast is at risk for the development of cancer in the remaining breast; therefore breast self-examination is important. Wearing a supportive brassiere limits incisional discomfort. There may or may not be a wound drainage system in place, and the timing of its removal is individualized. With the removal of breast tissue specific exercises are needed to prevent muscle atrophy and contractures; the right and left arms should be exercised at the same time.

A nurse is obtaining a health history from a client with newly diagnosed cervical cancer. Which aspect of the client's life is most important for the nurse to explore at this time? 1 Sexual history 2 Support system 3 Obstetric history 4 Elimination patterns

2 Support system During a health crisis the client will need support from significant others. The sexual history is important in diagnosis and the obstetric history and elimination patterns are important parts of the medical history; however, none are the priority at this time.

The healthcare team is caring for a client who has undergone surgery for lung cancer. The client needs respiratory therapy. Which task can be safely delegated to a respiratory therapist paired with a registered nurse? 1. Placing a Foley catheter 2. Assessing the respirations 3. Placing an intravenous (IV) catheter 4. Administering patient-controlled analgesia

2 Respiratory therapy is needed in clients who undergo surgery for lung cancer. Assessing respiration can be safely delegated to the respiratory therapist. Placing a Foley catheter, an IV catheter, or administering patient-controlled analgesia is within the scope of a registered nurse's practice.

When a client with cancer reaches an incurable last stage, the nurse explains the situation to the client and calls the client's family members to provide support. Which need of the client does the nurse prioritize here? 1. Safety need 2. Belonging need 3. Self-esteem need 4. Self-actualization need

2 The client at an incurable stage of cancer might need the support of loved ones for emotional support. Therefore the belonging need is fulfilled through this action. Safety needs may not be the top priority of the client at this stage. Self-esteem needs may be fulfilled through recognition and personal growth. Self-actualization needs may not be a priority for the client.

The home health nurse provides education to a client with cancer of the tongue who will begin gastrostomy feedings at home. Which statement by the client indicates teaching by the nurse is effective? 1 "Before I start the procedure, I will don sterile gloves." 2 "Before I start the procedure, I will obtain my body weight." 3 "Before I start the procedure, I will measure the residual volume." 4 "Before I start the procedure, I will instill one ounce (30 mL) of a carbonated liquid."

3 "Before I start the procedure, I will measure the residual volume." Measuring the residual volume establishes whether an adequate volume of the previous feeding was absorbed. If a residual exceeds the parameter identified by the healthcare provider or is over 200 mL, a feeding may be held. This prevents adding excess feeding solution that may lead to abdominal distention, nausea, vomiting, and aspiration. Clean, not sterile, gloves are necessary to protect the client from contamination with gastric secretions. Weights are taken and reported weekly or monthly depending on the client's condition and clinical goals. A carbonated beverage may be used if the tube becomes clogged; it is not used routinely.

A client with cancer of the bladder is admitted to the hospital for diagnostic tests to determine the extent of the disease. While the nurse is caring for the client, the client asks, "If they remove my bladder, how will I be able to urinate?" Which is the best response by the nurse? 1 "You can still function normally without a bladder." 2 "I am sure this is very upsetting to you, but it will be over soon." 3 "I know you're upset, but there are alternatives to removing your bladder." 4 "The tests will help to determine whether your bladder has to be removed."

3 "I know you're upset, but there are alternatives to removing your bladder." The response "I know you're upset, but there are alternatives to removing your bladder" offers the best combination of factual information and emotional support. The response "You can still function normally without a bladder" disregards the client's feelings; it is inaccurate information, because if the bladder is removed, bladder function will not be normal. Although the response "I am sure this is very upsetting to you, but it will be over soon" identifies the client's feelings, further communication is cut off by the second part of the response. The response "The tests will help to determine whether your bladder has to be removed" is factual but does not answer the question or offer emotional support; it may increase anxiety.

A client receiving chemotherapy for cancer develops sores in the mouth and asks the nurse why this happened. What is the nurse's best response? 1 "The sores occur because of the direct irritating effects of the drug." 2 "These tissues are poorly nourished because you have a decreased appetite." 3 "The frequently dividing cells of the gastrointestinal tract are damaged by the drug." 4 "This side effect occurs because it targets the cells of the gastrointestinal system."

3 "The frequently dividing cells of the gastrointestinal tract are damaged by the drug." Many chemotherapeutic agents function by interfering with DNA replication associated with cellular reproduction (mitosis). Frequent cellular mitosis of the stratified squamous epithelium of the mouth and anus results in these areas being powerfully affected by the drugs. The response "The sores occur because of the direct irritating effects of the drug" is inaccurate; most agents are administered parenterally. A decreased appetite (anorexia) does not cause stomatitis. Chemotherapeutic agents affect most rapidly proliferating cells, which include not only the cells of the gastrointestinal epithelium but also those of the bone marrow and hair follicles.

A nurse is planning care for a client with cancer who is receiving the plant alkaloid vincristine. In contrast to the side effects of most chemotherapeutic agents, what is a common side effect of vincristine that the nurse must address in the client's care plan? 1 Nausea 2 Alopecia 3 Constipation 4 Hyperuricemia

3 Constipation Although most chemotherapy causes diarrhea, vincristine can cause severe constipation, impaction, or paralytic ileus. Nausea, alopecia, and hyperuricemia are side effects shared with most other chemotherapeutic agents.

A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. What explanation will the nurse provide? 1 Steroid hormones have a depressant effect on the spleen and bone marrow. 2 Lymph node activity is depressed by radiation therapy used before chemotherapy. 3 Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. 4 Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration

3 Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. Chemotherapy destroys erythrocytes, white blood cells, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are vulnerable to the effects of chemotherapy. Stating that steroid hormones have a depressant effect on the spleen and bone marrow is not a true description of the side effects of steroids. Depressed lymph node activity as a result of radiation therapy used before chemotherapy is not the cause for fewer erythrocytes, white blood cells, and platelets. Although it is true that dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration, this does not explain pancytopenia.

A 28-year-old woman is diagnosed as having cancer of the left breast. A simple mastectomy is performed. What should the plan of care include immediately after surgery? 1 Changing the client's pressure dressing as necessary 2 Inviting a member of Reach to Recovery to visit the client 3 Placing the client in the semi-Fowler position with the left arm elevated 4 Waiting for a cessation of drainage before the client resumes any activity

3 Placing the client in the semi-Fowler position with the left arm elevated The semi-Fowler position and elevation of the arm on the affected side minimize edema related to the inflammatory process. Pressure dressings are rarely used because portable wound drainage systems are used to remove accumulated fluid from the surgical site. A member of Reach to Recovery will not visit on the day of surgery; the visit will probably be made in the client's home. Activities of daily living that necessitate only slight flexion of the elbow and do not involve abduction of the arm on the affected side are permitted.

After an above-the-knee amputation for bone cancer, an adolescent boy is returned to his room. He is monitored closely because of the potential for hemorrhage from the residual limb. What should the nurse plan to keep at the bedside? 1 Hemostat 2 Vitamin K 3 Pressure dressing 4 Protamine sulfate

3 Pressure dressing A pressure dressing will control hemorrhage until surgical intervention can be instituted. A hemostat is not practical because bleeding may be internal. Vitamin K is the antidote for warfarin (Coumadin). There is no indication that the client is taking Coumadin. Protamine sulfate is the antidote for an excessive amount of heparin; the client is not receiving heparin.

The nurse manager oversees an organization that provides secondary care for clients with cancer. Which service would be provided by this type of organization? 1 Providing long-term care for fatigue 2 Providing treatment for pain management 3 Teaching the client about prevention of infection 4 Teaching the client about adverse effects of the therapy

3 Teaching the client about prevention of infection Secondary care involves the prevention of disease complications. Therefore teaching clients about the prevention of the infection would help prevent complications as cancer clients are at high risk for infection. Long-term care for fatigue would be included as primary or tertiary care, not secondary care. Treatment for chronic care such as pain management in cancer clients is a type of primary care provided to a client. Primary care involves health maintenance measures such as teaching the client about adverse effect of the therapy.

The nurse instructs a client suspected of bladder cancer to discard the morning first-voided urine and to collect a fresh urine specimen. The nurse also sends the specimen to the laboratory within 1 hour of collection. Which diagnostic procedure requires this intervention? 1 Residual urine 2 Concentration test 3 Urine cytologic study 4 Protein determination

3 Urine cytologic study For urine cytologic study, the morning's first voided specimen is not used because epithelial cells may change in appearance in the urine held in the bladder overnight. Therefore, urine cytologic study requires this intervention with a fresh urine sample. Residual urine tests, concentration tests, and protein determination tests do not require this intervention. Catheterization or bladder ultrasound equipment are used in a client prescribed with a residual urine test after the client has voided. The concentration test requires the client to fast after a given time in the evening and then three urine specimens are collected in hourly intervals. A dipstick may be used to test the protein levels in the urine.

The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. 1 Monitor for signs of alopecia. 2 Encourage an increase in fluids. 3 Wash hands before entering the client's room. 4 Advise use of a soft toothbrush for oral hygiene. 5 Report an elevation in temperature immediately. 6 Encourage the client to eat raw, fresh fruits and vegetables

3, 4, 5, It is essential to prevent infection in a client with severe bone marrow depression; thorough handwashing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary healthcare provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables and undercooked meat, eggs, and fish to prevent possible exposure to microbes.

A nurse in the women's health clinic is counseling clients about the signs of gynecologic problems. Teaching by the nurse would be deemed effective if the clients stated that which early manifestation of cervical cancer should prompt them to seek professional care? 1 Abdominal heaviness 2 Pressure on the bladder 3 Foul-smelling discharge 4 Bloody spotting after intercourse

4 Bloody spotting after intercourse Any sign of abnormal vaginal bleeding may indicate cervical cancer and must be investigated. Discomfort is a late sign of cervical cancer, because there are few nerve endings in this area. The cancer must be extensive to cause pressure. Discharge becomes foul smelling after there is necrosis and infection; it is not an early sign.

A client with esophageal cancer is to receive total parenteral nutrition. A right subclavian catheter is inserted. What is the primary reason total parenteral nutrition is infused through a central line rather than a peripheral line? 1 It prevents the development of infection. 2 There is less chance of this infusion infiltrating. 3 It is more convenient so clients can use their hands. 4 The large amount of blood helps dilute the concentrated solution.

4 The large amount of blood helps dilute the concentrated solution. Unless diluted by the increased blood flow, the highly concentrated solution can cause injury to the veins. The potential of infection is high with parenteral nutrition because of the increased glucose levels. The other options are not the primary reason, although the infusion at this site is more secure and promotes free use of the arms and hands.

Which vaccine provides protection from precancerous lesions and cancers of the vulva, cervix, and vagina in young girls and women? 1 Rotarix 2 Varivax 3 Gardasil 4 Menactra

3 Gardasil Gardasil is a human papilloma virus (HPV) vaccine used to help prevent precancerous lesions of the cervix, vulva, and vagina caused by HPV types 16 and 18. Rotarix is a monovalent vaccine developed to provide protection against certain rotaviruses, such as G1, G3, G4, and G9. Varivax is a vaccine administered to provide protection against the varicella virus. Menactra is a tetravalent conjugate vaccine that provides protection against certain serotypes of meningococcus, such as A, C, Y, and W-135.

A 63-year-old woman with the diagnosis of estrogen receptor-positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen is prescribed. The client asks the nurse how long she will have to take the medication. How will the nurse respond? 1 "You'll have to take it for the rest of your life." 2 "You'll need to take it for 10 days, like an antibiotic." 3 "You'll need to take it for 5 years, after which it will be discontinued." 4 "You'll need to take it for several months, until the bone pain subsides."

3 "You'll need to take it for 5 years, after which it will be discontinued.". Tamoxifen is an estrogen antagonist antineoplastic medication that has been found to be effective in 50% to 60% of women with estrogen receptor-positive cancer of the breast. After 5 years of administration there is an increased risk of complications, and the drug is discontinued. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not for the rest of the client's life; this duration will not produce positive effects for the client. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not just for 10 days. Tamoxifen may cause the adverse effect of bone pain, which indicates the drug's effectiveness. Medication is given to manage the pain and the drug is continued.

A client has cancer of the cervix. Which response after radium insertion should cause the nurse to recognize that the client is having an adverse reaction to the radium? 1 Vomiting 2 Back pain 3 Vaginal discharge 4 Increased temperature

4 Increased temperature

A client in the final stage of cancer is very anxious about his or her disease. The client is showing aggressive behavior towards family members. The nurse comforts and offers compassion and empathy to the client and the family members. Which theory principle is the nurse following in this situation? 1 Roy's Theory 2 Watson's Theory 3 Leininger's theory 4 Henderson's theory

2 Watson's Theory Watson's theory involves assisting the clients in attaining health, maintaining health, or dying peacefully. As per Watson's theory, the nurse should comfort and offer compassion and empathy to clients and their families. Roy's theory identifies the types of demands placed on the client and helps the client adapt to changes in his or her physiological needs. Leininger's theory is about transcultural care theory, which explains that caring is the central and unifying domain for nursing knowledge and practice. Henderson's theory illustrates that nurses working interdependently with other healthcare workers can best assist the client.

The nurse is performing a breast assessment. Which statement made by the client indicates the risk of breast cancer? Select all that apply. 1 "I had a late onset of menarche." 2 "My first child was born when I was 32." 3 "I noticed a slight discharge from a nipple." 4 "I perform breast self-examinations frequently." 5 "I consume two to four glasses of alcohol a day."

2, 3, 5 Clients who gave birth to a first child after the age of 30 are at a risk of breast cancer. Discharge from the nipple may indicate an early symptom of breast cancer. Consuming two to four glasses of alcohol daily may also increase the risk of breast cancer. An early onset of menarche is a risk factor for breast cancer. Performing breast self-examinations frequently may help to identify the early stages of breast cancer.

After thoracic surgery for removal of a cancerous lesion in the lung, the client is drowsy, complains of pain when awakened, and then falls asleep. The client has a prescription for morphine sulfate via IV every 3 hours as needed for pain. The client's preoperative blood pressure was 128/76 mm Hg. Postoperative assessments reveal that the client's blood pressure ranges between 90/60 and 100/70 mm Hg. What is the nurse's best initial action? 1 Administer morphine as prescribed. 2 Obtain a prescription for a vasoconstrictor. 3 Give half the prescribed amount of morphine. 4 Withhold morphine until the blood pressure stabilizes.

4 Withhold morphine until the blood pressure stabilizes. Morphine may decrease the blood pressure further; clients who are drowsy may sleep without medication immediately after surgery. The healthcare provider should be notified to reevaluate pain management. Administering the morphine is contraindicated because morphine is an opioid analgesic that can lower further the blood pressure. A vasoconstrictor will not relieve the pain. Administration of a medication dosage other than that prescribed is not an independent nursing function.

A direct care nurse performs exceedingly well on a cancer project. As a result, the managerial team decides to promote the nurse to a managerial position. Which actions by the nurse would justify the decision of the panel? Select all that apply. 1 Inspiring new ideas 2 Establishing short-term goals 3 Demonstrating positive feelings 4 Maximizing results from existing resources 5 Showing willingness to both lead and follow peers

1 Inspiring new ideas 2 Establishing short-term goals 3 Demonstrating positive feelings 4 Maximizing results from existing resources The leader provides new ideas with a long-term effect on the progress of the organization. He/she should also provide a positive atmosphere by giving an equal importance to the followers. Providing short-term goals and maximizing results from existing resources are the job responsibilities of a manager. The willingness to lead and follow peers is the quality of a good follower

The nurse is caring for a client undergoing chemotherapy for cancer treatment. The client's laboratory results indicate bone marrow suppression. What will the nurse encourage the client to do? 1 Use an electric razor when shaving 2 Drink citrus juices frequently for nourishment 3 Increase activity level by ambulating frequently 4 Sleep with the head of the bed slightly elevated

1 Use an electric razor when shaving Suppression of bone marrow increases bleeding susceptibility associated with decreased platelets. Drinking citrus juices frequently for nourishment does not offer an advantage. The client receiving chemotherapy because of the side effects of stomatitis should avoid citrus juices. With bone marrow suppression there is a decrease in red blood cells to meet cellular oxygen needs; rest should be encouraged, if needed. Sleeping with the head of the bed slightly elevated does not offer any specific advantage; the client should sleep in the position of comfort.

The nurse is caring for several adolescent clients. Which are at increased risk for testicular cancer? Select all that apply. 1 Client with infertility 2 Client with hemophilia 3 Client with liver disease 4 Client with cryptorchidism 5 Client with Klinefelter syndrome

1, 4, 5 Risk factors for testicular cancer include cryptorchidism, Klinefelter syndrome, and infertility. The client with liver disease may be at increased risk of gynecomastia. Hemophilia, a hematologic disorder, is not a risk factor for testicular cancer.

A client who is to receive radiation therapy for cancer says to the nurse, "My family said I will get a radiation burn." What is the nurse's best response? 1 "Your skin will look like a blistering sunburn." 2 "A localized skin reaction usually occurs." 3 "A daily application of an emollient will prevent a burn." 4 "Your family must have had experience with radiation therapy."

2 "A localized skin reaction usually occurs." Radiodermatitis occurs 3 to 6 weeks after the start of treatment. The word "burn" should be avoided because it may increase anxiety. Emollients are contraindicated; they may alter the calculated x ray route and injure healthy tissue. The response about the client's family does not address the client's concern.

A client with radiation therapy for neck cancer reports, "I feel a lump while swallowing and foods get stuck." What does the nurse document in the client's medical history? 1 Dysgeusia 2 Dysphagia 3 Xerostomia 4 Odynophagia

2 Dysphagia Dysphagia is having difficulty while swallowing. This characterizes pharyngeal and esophageal involvement, which further impedes eating. In this condition, the client may report a feeling of having a "lump" when swallowing and feeling that "foods get stuck." Dysgeusia is the loss of taste; clients will report that all food has lost its flavor. While xerostomia may contribute to difficulty swallowing, it is not the term used; xerostomia is used to indicate dry mouth. Odynophagia is painful swallowing; clients will report severe pain while swallowing.

72.A nurse is caring for a client who is receiving internal radiation for cancer of the cervix. For which adverse reactions to the radiotherapy should the client be monitored? Select all that apply. 1 Nausea 2 Hemorrhage 3 Restlessness 4 Vaginal discharge 5 Increased temperature

2, 5 Excessive sloughing of tissue may cause hemorrhage and is considered an adverse reaction. Infection, marked by an increase in temperature, may also develop from excessive sloughing of tissue. Nausea is an expected side effect of internal radiotherapy. Restlessness is not a sign of an adverse reaction; it is associated with a need to maintain a set position to prevent the applicator from being dislodged. Vaginal discharge is an expected side effect of internal radiotherapy.

While awaiting the biopsy report before removal of a bone tumor, the client reports being afraid of a diagnosis of cancer. How should the nurse respond? 1 "Worrying is not going to help the situation." 2 "Let's wait until we hear what the biopsy report says." 3 "It is very upsetting to have to wait for a biopsy report." 4 "Operations are not performed unless there are no other options."

3 "It is very upsetting to have to wait for a biopsy report." "It is very upsetting to have to wait for a biopsy report" addresses the fact that the client's feelings of anxiety are valid. Stating "Worrying is not going to help the situation" or "Let's wait until we hear what the biopsy report says" does not address the client's concerns and may inhibit the expression of feelings. Telling the client that operations are not performed unless there are no other options is irrelevant and does not address the client's concerns.

The nurse is performing an assessment of the client's reproductive system. Which finding of the past medical history indicates the client is at risk of cervical cancer? 1 Vaginal discharge 2 Ovarian dysfunction 3 Human papilloma virus infection 4 Hematuria and urinary incontinence

3 Human papilloma virus infection A human papilloma virus (HPV) infection increases the risk of cervical cancer. The presence of vaginal discharge may indicate a sexually transmitted disease. A history of ovarian dysfunction may increase the risk of ovarian cancer. The presence of hematuria and urinary incontinence may indicate urinary problems associated with gynecological disorders.

The alkylating agent cyclophosphamide is prescribed for a school-aged child with cancer. What is the most important sign or symptom for the nurse to be alert for while the child is receiving this medication? 1 Irritability 2 Unpredictable nausea 3 Pain with urination 4 Hyperplasia of the gums

3 Pain with urination Cystitis is a potentially serious adverse reaction to cyclophosphamide; it sometimes can be prevented by increasing hydration because the fluid flushes the bladder. Irritability may be present but is not a result of cyclophosphamide administration. Unpredictable nausea is an expected but manageable side effect of cyclophosphamide. Hyperplasia of the gums is unrelated to cyclophosphamide administration; it may occur with prolonged phenytoin therapy

A client develops severe bone marrow suppression related to cancer treatment. What is important for the nurse to include in the client's teaching? 1 Be prepared to experience alopecia. 2 Increase fluids to at least 3 liters/day. 3 Use a soft toothbrush for oral hygiene. 4 Monitor your intake and output of fluids

3 Use a soft toothbrush for oral hygiene Thrombocytopenia occurs with several cancer treatment programs; using a soft toothbrush helps prevent bleeding gums. Although alopecia does occur, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Monitoring intake and output of fluids is not related to bone marrow suppression.

Which drug would place a client's offspring at risk for vaginal cancer? 1 Danazol 2 Estrogen 3 Valproic acid 4 Diethylstilbestrol

4 DiethylstilbestroL Diethylstilbestrol is a synthetic nonsteroidal estrogen used in the treatment of menopausal and postmenopausal disorders. When it is consumed during pregnancy, it may show the delayed teratogenic effect of vaginal cancer in female offspring by the age of 18. Danazol is an androgen that may cause masculinization of the female fetus. Estrogen causes congenital defects of the female reproductive organs. Valproic acid, a drug used to control seizures, may cause neural tube defects.

A client using fentanyl transdermal patches for pain management in late-stage cancer dies. What should the hospice nurse who is caring for this client do about the patch? 1 Tell the family to remove and dispose of the patch. 2 Leave the patch in place for the mortician to remove. 3 Have the family return the patch to the pharmacy for disposal. 4 Remove and dispose of the patch in an appropriate receptacle.

4 Remove and dispose of the patch in an appropriate receptacle. The nurse should remove and dispose of the patch in a manner that protects self and others from exposure to the fentanyl. Having the family remove and dispose of the patch or having the mortician remove the patch is not safe. It is not the responsibility of nonprofessionals because they do not know how to protect themselves and others from exposure to the fentanyl. It is unnecessary to return a used fentanyl patch to the pharmacy.

A client who is to undergo a mastectomy for breast cancer tells the nurse that she is worried about what she will look like after the surgery. What is the most appropriate initial response by the nurse? 1 "I understand that you'd be concerned." 2 "Try not to think about the surgery now." 3 "Everyone having this surgery feels the same way." 4 "Perhaps you should discuss this with your husband."

1 "I understand that you'd be concerned." Women facing breast surgery often have feelings relating to their sexuality and change in body image; the nurse plays a vital role in helping the client verbalize feelings, and this response keeps channels of communication open. The client's concerns are real, and a statement such as "Try not to think about the surgery now" will only block further communication. The response "Everyone having this surgery feels the same way" does not focus on the importance of the client as an individual; each person feels differently. The response "Perhaps you should discuss this with your husband" can be interpreted as the nurse's reluctance to listen; the client may not be able to talk with the husband about this.

The nurse is performing a skin assessment of a client. Which findings in the client may indicate a risk of skin cancer? Select all that apply. 1 Lesion 2 Lumps 3 Rashes 4 Bruising 5 Dryness

1 Lesion 2 Lumps 3 Rashes Lesions on the skin that take a long time to heal may indicate skin cancer. Lumps and rashes on the skin are characteristics of skin cancer. Bruising may indicate a bleeding disorder or injury. Dryness of the skin may be due to excessive bathing and use of harsh soaps

The nurse is preparing to educate a group of clients about health promotion to prevent head and neck cancer. Which clients are of highest priority for education? Select all that apply. 1 A client who chews tobacco 2 A client who has multiple sex partners 3 A client who uses condoms when having sex 4 A client with a history of alcohol abuse for 5 years 5 A client who brushes with a soft bristle toothbrush

1, 2, 4 Tobacco, alcohol, and human papilloma virus (HPV) are the major causes of neck cancer. The nurse should counsel the client who chews tobacco and educate regarding the importance of oral hygiene. The nurse should advise the client to stop chewing tobacco to reduce the risk of head and neck cancer. The nurse should educate the client with multiple sex partners about protecting against human papilloma virus (HPV), which is a risk factor for cancer. The nurse should place a high priority on health promotion in a client with a history of alcohol abuse for 5 years because it is one of the major risk factors for head and neck cancer. The client should use condoms when having sex with potentially infectious partners to prevent HPV infections that can lead to head and neck cancer. A client should maintain proper oral hygiene by brushing his or her teeth regularly with a soft bristle brush and flossing.

A client with cancer is receiving a multiple chemotherapy protocol. Included in the protocol is leucovorin. The nurse concludes that this drug is administered for what purpose? 1 To potentiate the effect of alkylating agents 2 Because it diminishes toxicity of folic acid antagonists 3 To limit the occurrence of vomiting associated with chemotherapy 4 Interference with cell division at a different stage of cell division than the other drugs

2 Because it diminishes toxicity of folic acid antagonists Leucovorin limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells. Leucovorin does not potentiate the effect of alkylating agents; however, leucovorin promotes binding of fluorouracil (5-FU) to target tumor cells. Antiemetics such as prochlorperazine maleate and ondansetron minimize nausea and vomiting associated with chemotherapeutic agents. Leucovorin does not interfere with cell division; this is the purpose of a multiple-drug protocol.

A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for what purpose? 1 Stimulate production of gastrointestinal secretions 2 Enhance relaxation of the upper gastrointestinal tract 3 Prolong excretion of the chemotherapeutic medication 4 Increase absorption of the chemotherapeutic medication

2 Enhance relaxation of the upper gastrointestinal tract The relaxation effect increases the passage of food through the gastrointestinal tract, limiting reverse peristalsis, gastroesophageal reflux, and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of gastrointestinal secretions. Metoclopramide has no effect on the excretion of chemotherapeutic medications. Metoclopramide has no effect on the absorption of chemotherapeutic medications.

The father of a child who is dying of cancer asks the nurse whether he should tell his 7-year-old son that his sister is dying. What is the most appropriate response by the nurse? 1 "He can't comprehend the real meaning of death, so don't tell him until the last minute." 2 "Your son probably fears separation most and wants to know that you will care for him, rather than what will happen to his sister." 3 "You should talk this over with your healthcare provider, who probably knows best what's happening in terms of your daughter's prognosis." 4 "Your son probably doesn't understand death as we do but fears it just the same. He should be told the truth to let him prepare for his sister's death."

4 "Your son probably doesn't understand death as we do but fears it just the same. He should be told the truth to let him prepare for his sister's death." Children of early school age are not yet able to comprehend death's universality and inevitability, but they still fear it, often personifying death as a "boogeyman" or "death angel." They need an opportunity to prepare for a coming death. At age 10 this child needs to know the seriousness of the illness and to understand that recovery may not be possible. Children younger than age 10 interpret death as separation and punishment; they fear this in addition to death itself. Telling the father to talk to the healthcare provider only avoids the question.

A client who has been told she needs a hysterectomy for cervical cancer is upset about being unable to have a third child. Which action should the nurse take next? 1 Evaluate her willingness to pursue adoption. 2 Encourage her to focus on her own recovery. 3 Emphasize that she does have two children already. 4 Ensure that other treatment options for her will be explored

4 Ensure that other treatment options for her will be explored. Although a hysterectomy may be performed, conservative management may include cervical conization [1] [2] [3] and laser treatment that do not preclude future pregnancies; clients have a right to be informed by their primary healthcare provider of all treatment options. Willingness to pursue adoption currently is not the issue for this client. Encouraging her to focus on her own recovery and emphasizing that she does have two children already negate the client's feelings.

A client with small-cell lung cancer is receiving chemotherapy. A complete blood count is prescribed before each round of chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? 1 Platelets 2 Hematocrit 3 Red blood cells (RBCs) 4 White blood cells (WBCs)

4 White blood cells (WBCs) Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life threatening. RBCs diminish slowly and can be replaced with a transfusion of packed red blood cells. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.

A client with cancer of the cervix has an intracavity radioactive sealed implant in place. What precaution should the nurse take to protect against excessive exposure to radiation? 1 Disposing of body fluids in specially marked containers 2 Cohorting two clients who have implanted radiation therapy 3 Exiting the room walking backward while wearing a lead apron 4 Limiting visitors to individuals who are 13 years of age and older

t Exiting the room walking backward while wearing a lead apron Aprons do not protect the posterior side of the caregiver; therefore the nurse should always keep the front of the apron facing the source of radiation. Disposing of body fluids in specially marked containers is unnecessary. Body fluids of clients with unsealed, not sealed, implants may be contained in a specially marked container; others are allowed to use a toilet followed by several flushes. Clients undergoing radioactive sealed or unsealed therapy should be in a private room with a private bath. This protects other clients receiving internal radiation from excessive exposure. Visiting should be limited to those individuals who are 16 years of age and older. Visits should last no longer than 30 minutes daily. Visitors should be taught to maintain a 6-foot distance from the source of the radiation.

Which surgical procedure is appropriate for the removal of a vocal cord due to laryngeal cancer? 1 Cordectomy 2 Tracheotomy 3 Total laryngectomy 4 Oropharyngeal resections

1 Cordectomy A cordectomy is a surgical procedure performed in clients with laryngeal cancer; this surgery involves the removal of a vocal cord. A tracheotomy is a surgical incision in the trachea for the purpose of establishing an airway. A total laryngectomy is a surgical procedure in which the entire larynx, hyoid bone, strap muscles, and one or two tracheal rings are removed. A nodal neck dissection is also done in a total laryngectomy if the nodes are involved. An oropharyngeal resection is a surgical procedure performed to treat cancer of the oropharynx.

A client expresses concern about being exposed to radiation therapy because it can cause cancer. What should the nurse emphasize when informing the client about exposure to radiation? 1 The dosage is kept at a minimum. 2 Only a small part of the body is irradiated. 3 The client's physical condition is not a risk factor. 4 Nutritional environment of the affected cells is a risk factor

2 Only a small part of the body is irradiated. Current radiation therapy accurately targets malignant lesions with pinpoint precision, minimizing the detrimental effects of radiation to healthy tissue. The dose is not as significant as the extent of tissue being irradiated. When radiation therapy is prescribed, the healthcare provider takes into consideration the ability of the client to tolerate the therapy, determining that the benefit outweighs the risk. Nutritional environment of the affected cells does not influence radiation's effect.

A client who has cervical cancer is hospitalized for internal radiation therapy. What is the nursing intervention after the radiation source is loaded? 1 Ensuring that the client's diet is low residue 2 Placing the client in the high-Fowler position 3 Checking the client's voiding and catheterizing if necessary 4 Staying with the client for half an hour and assessing her for signs of radiation sickness

1 Ensuring that the client's diet is low residue Clients with internal radiation for cervical cancer are given a low-residue diet and often medications to suppress peristalsis and prevent pressure from bowel movements. The necessity for this altered diet should be explained to the client. If the head of the bed is elevated, the implant may be dislodged by gravity. A catheter is inserted routinely before loading to prevent bladder distention and possible radiation damage or alteration of implant position. Because the client is the source of radiation, the nurse must limit the time spent with the client to prevent excessive exposure.

Which carcinoma is the most common type of thyroid cancer and is most often found in younger women? 1 Papillary carcinoma 2 Follicular carcinoma 3 Medullary carcinoma 4 Anaplastic carcinoma

1 Papillary carcinoma Papillary carcinoma is the most common type of thyroid cancer; it is most often seen in younger women. Follicular carcinoma occurs most often in older adults. Medullary carcinoma is seen mostly in clients older than 50 years. Anaplastic carcinoma is a rapid-growing, aggressive tumor.

An elderly client undergoing cancer therapy reports diffused redness and large blisters on the skin with evident systemic toxicity. What should be the priority intervention in this client? 1 Discontinue the drug 2 Monitor body temperature 3 Monitor fluid and electrolyte balance 4 Administer topical antibacterial medication

1 Discontinue the drug Toxic epidermal necrolysis (TEN) is a rare acute drug reaction that manifests as diffused redness and large blisters on the skin. Elderly clients on chemotherapy are at greater risk for TEN. Therefore the drug should be immediately discontinued to reduce further damage to the skin. Monitoring the body temperature is not a priority intervention in this client. The client should be monitored for hypothermia and fluid and electrolyte balance to provide systemic support and prevent secondary infections. Topical antibacterial drugs are administered to suppress the bacterial growth until healing occurs.

A mother with newly diagnosed ovarian cancer knows that she must tell her 8-year-old child about the diagnosis and how her upcoming treatment will affect their family life. She asks the nurse how she should answer if her child asks, "Are you going to die?" What should the nurse advise the mother to answer? 1 "No, but why do you ask that?" 2 "I might, but can we talk about this later?" 3 "Everyone dies, but I'll be around for a long time." 4 "I don't know, but I'm going to try very hard to stay alive."

4 "I don't know, but I'm going to try very hard to stay alive." In the first discussion the mother should convey some facts, but not overload the child with details, and offer hope; honest answers are important for the child's sense of security and well-being. An 8-year-old child may not be able to respond to the "Why?" question and become anxious, overwhelmed, and defensive. Avoiding an answer may close off communication and increase feelings of uncertainty and anxiety. Promising to stay alive constitutes false reassurance because the mother's prognosis is uncertain at this time.

A nurse manager in a cancer care facility finds that the nursing care team is demotivated due to consecutive deaths of two terminally ill cancer clients. Which action of the nurse manager would help renew the team's energy? 1. Counseling the team members that death is an inevitable part of chronic diseases 2. Shifting the team to another nursing unit with less likelihood of deaths occurring 3. Instructing the team members to be emotionally detached from the clients they care for 4. Arranging a notice board in the unit and posting photos or messages reflecting achievements of the team

4 Arranging a notice board in the unit and posting photos or messages reflecting achievements of the team A good leader keeps the team's spirits high by helping them renew their energy levels. The nurse manager may post motivating messages or photos on the notice board to motivate the team members. Counseling the team members may not help in motivating them as there could be further similar incidences in the unit. Shifting the team to another nursing unit with less likelihood of deaths may make the team members emotionally weak. The reason for the team members to be low in energy is unlikely to be their emotional attachment to the clients; keeping them emotionally detached may not help motivate them for client care.

A client has colorectal cancer and is receiving cetuximab. Which process does cetuximab inhibit? 1 Proteasome activity 2 BCR-ABL tyrosine kinase (TK) 3 Anaplastic lymphoma kinase 4 Epidermal growth factor receptors (EGFRs)

4 Epidermal growth factor receptors (EGFRs) Cetuximab is an EGFR-tyrosine TK inhibitor that acts by inhibiting EGFRs in clients with colorectal cancer. Bortezomib inhibits proteasome activity in clients with multiple myeloma. Dasatinib acts by inhibiting BCR-ABL TK in clients with chronic myeloid leukemia. Crizotinib acts by inhibiting anaplastic lymphoma kinase (ALK) in clients with locally advanced or metastatic non-small cell lung cancer that is ALK positive.

After 2 weeks of radiation therapy for cancer of the breast a client experiences some erythema over the area being irradiated. The area is sensitive but not painful. The client states that she has been using tepid water and a soft washcloth when cleansing the area and applying an ice pack three times a day. What does the nurse conclude from this information? 1 Further teaching on skin care is necessary. 2 No other intervention is needed at this time. 3 The radiation team should be notified of this problem. 4 Health teaching on the side effects of radiation is needed

1 Further teaching on skin care is necessary. Further teaching is needed because extremes of temperature should be avoided; ice constricts blood vessels, interfering with circulation. Continued application of cold is contraindicated because it may cause tissue damage. Erythema is an expected reaction; however, pain, vesicle formation, or sloughing of tissue requires intervention. The knowledge deficit is related to skin care, not the side effects of radiation therapy.

A client with positive family history of testicular cancer arrives at the hospital and reports testicular pain. The primary healthcare provider reviews the laboratory reports and makes a diagnosis of testicular cancer. After surgery, the client will undergo chemotherapy. What conditions might occur in this client after chemotherapy? Select all that apply. 1 Infertility 2 Varicocele 3 Heart disease 4 Penile carcinoma 5 Metabolic syndrome

1 Infertility 3 Heart disease 5 Metabolic syndrome A family history of testicular cancer is a risk factor for testicular cancer. The client with testicular cancer may report pain in the testicular region. Radical inguinal orchiectomy, chemotherapy, and radiotherapy would be beneficial for this client. Chemotherapy can cause infertility. It can also cause cardiovascular disease and metabolic syndrome. Varicocele is characterized by elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle, not with chemotherapy for testicular cancer. Penile carcinoma is commonly associated with human papillomavirus type 16 infection.

A client is to receive intraarterial chemotherapy for cancer of the liver. What benefit of chemotherapy via this method does the nurse explain to the client? 1 It reduces systemic toxicity. 2 It provides for rapid dilution of chemotherapy. 3 The drug is able to pass the blood-brain barrier. 4 The chemotherapy is delivered to the peritoneal cavity.

1 It reduces systemic toxicity. Higher concentrations of the drug can be delivered to the specific site of the tumor, with reduced systemic toxicity. Providing for rapid dilution of chemotherapy is the purpose of central vascular access devices. The ability to pass the blood-brain barrier is the purpose of intrathecal or intraventricular access devices. Delivering chemotherapy to the peritoneal cavity is the purpose of intraperitoneal chemotherapy; temporary Silastic catheters are used.

A nurse is assessing a 55-year-old client who is experiencing postmenopausal bleeding. The tentative diagnosis is endometrial cancer. Which findings in the client's history are risk factors associated with endometrial cancer? Select all that apply. 1 Obesity 2 Multiparity 3 Cigarette smoking 4 Early onset of menopause 5 Family history of endometrial cancer 6 Previous hormone replacement therapy

1 Obesity 5 Family history of endometrial cancer 6 Previous hormone replacement therapy Obesity is a risk factor for endometrial cancer, because adipose cells store estrogen; the extent of exposure to estrogen is the most significant risk factor. Nulliparity, not multiparity, is a risk factor for endometrial cancer because of the increased exposure to estrogen. Cigarette smoking has not been identified as a risk factor for endometrial cancer. Late, not early, onset of menopause is a risk factor for endometrial cancer because of the increased exposure to estrogen. Although endometrial cancer has not been proved to have a genetic predisposition, it is more common in families who have gene mutations for hereditary nonpolyposis colon cancer

A women undergoing chemotherapy for cancer gave birth to a newborn with limb malformations. Which medication may cause limb malformations in the neonates? 1 Methotrexate 2 Nitrofurantoin 3 Carbamazepine 4 Cyclophosphamide

1 Methotrexate When taken during pregnancy, methotrexate may cause limb malformations. Nitrofurantoin is not an immunosuppressant; it may cause abnormally small eyes or absent eyes in fetuses. Carbamazepine is an antiepileptic drug that may cause neural tube defects. Cyclophosphamide may cause central nervous system malformations and secondary cancers.

A client suffering with cancer is at the last stage of life. Which actions should be performed by the nurse to support the client's family members? Select all that apply. 1 Helping the family to set up home care 2 Taking time to make sure that the family is comfortable 3 Staying with the client in the absence of family members 4 Giving the family about the information of dying process 5 Making sure that the family knows about what to do at the time of death

1, 4, 5 When the client is at the last stage of life, the nurse should help the family set up home care if they desire and obtain hospice and other appropriate resources, including grief support. The family members should be informed about the dying process. Make sure that the family knows what to do at the time of death. When the client is hospitalized, take time to make sure that the family is comfortable and stay with the client in the absence of their family members.

The nurse is teaching a client self-management of skin cancer. Which statement made by the client indicates the need for further learning? 1. "I should use sunscreen when going out." 2. "I should limit sun exposure to between 7 am and 12 pm." 3. "I should wear a hat and opaque clothing when going out." 4. "I should go for a monthly examination of cancerous and precancerous lesions."

2 In the self-management of skin cancer, the client should not go out in the sun between 11 am and 3 pm. This is the time when the sunlight is strongest. Using sunscreen protects a client's skin from the sun's rays. The client should wear a hat and opaque clothing when going out. Going for monthly examination of cancerous and precancerous lesions is recommended.

During a follow-up visit, a nurse finds that the client has a slow rate of healing after laryngeal cancer surgery. The nurse also finds that the client is at risk of developing lung cancer. What would be the reason behind the nurse's suspicion? 1 The client leans forward while coughing. 2 The client smokes four cigarettes per day. 3 The client avoids showering and swimming. 4 The client uses a non-oil-based ointment to lubricate the stoma

2 The client smokes four cigarettes per day. Smoking can increase the risk for developing other cancers such as lung cancer and can decrease the rate of healing from laryngeal surgeries. Leaning forward while coughing promotes healing. Avoiding showering and swimming helps to prevent water from entering the airways through the stoma. Using a non-oil-based ointment to lubricate the stoma may aid in quick healing.

A client with cancer of the thyroid is scheduled for a thyroidectomy. What should the nurse teach the client? 1 The dietary intake of carbohydrates must be restricted. 2 Thyroxine replacement therapy will be required indefinitely. 3 Chemotherapy may be used in conjunction with the surgery. 4 A tracheostomy requires an alternative means of communication.

2 Thyroxine replacement therapy will be required indefinitely. Thyroxine is given postoperatively to suppress thyroid-stimulating hormone (TSH) and prevent hypothyroidism. Increased intake of carbohydrates and proteins is needed because of the increased metabolic activity associated with hyperthyroidism. Chemotherapy is uncommon; radiation may be used to eradicate remaining tissue. A tracheostomy is not planned; it is needed only in an emergency related to respiratory distress.

A laboratory report shows that a client tested positive for human epidermal growth factor (HER), and a medical report reveals the presence of advanced breast cancer. Which medication would be used to treat this condition? 1. Erlotinib 2. Lapatinib 3. Rituximab 4. Tositumomab

2 HER-2 is overexpressed in clients with advanced breast cancer. Lapatinib inhibits epidermal growth factor-r (EGFR)-tyrosine kinase (TK) and binds HER-2. Erlotinib is an EFGR-TK inhibitor prescribed to treat non-small cell lung cancer and advanced pancreatic cancer. Rituximab and tositumomab are administered to treat non-Hodgkin's lymphoma.

While caring for a female client, the nursing student feels tenderness and a lump in the client's breast. The nursing student tells the registered nurse, "I think this client has breast cancer." Which statements of the registered nurse would be appropriate in accordance with the knowing element of Swanson's theory? Select all that apply. 1 "Try to comfort the client." 2 "Avoid making assumptions." 3 "Assess the client thoroughly." 4 "Check for other signs of breast cancer." 5 "Try to provide support and care to the client.

2, 3, 4 The knowing element of the caring process involves understanding an event. Avoiding assumptions, performing a thorough assessment of the client, and checking for other signs of breast cancer and are related to the knowing element of Swanson's theory of caring. The doing for element includes comforting the client. The caring process of being with involves the nurse providing emotional support.

Neomycin 1 gram is prescribed preoperatively for a client with cancer of the colon. The client asks why this is necessary. How should the nurse respond? 1 "It is used to prevent you from getting a bladder infection before surgery." 2 "It will decrease your kidney function and lessen urine production during surgery." 3 "It will kill the bacteria in your bowel and decrease the risk for infection after surgery." 4 "It is used to alter the body flora, which reduces spread of the tumor to adjacent organs."

3 "It will kill the bacteria in your bowel and decrease the risk for infection after surgery." Neomycin provides preoperative intestinal antisepsis. It is not administered to prevent bladder infection. Nephrotoxicity is an adverse, not a therapeutic, effect. Neomycin will not prevent metastasis of the tumor to other areas.

After recovery from a modified neck dissection for oropharyngeal cancer, the client receives external radiation to the operative site. For which most critical reaction to the radiation should the nurse assess the client? 1 Dry mouth 2 Skin reactions 3 Mucosal edema 4 Bone marrow suppressioN

3 Mucosal edema The mucosal lining of the oral cavity, oropharynx, and esophagus is sensitive to the effects of radiation therapy; the inflammatory response causes mucosal edema that may progress to an airway obstruction. A decrease in salivary secretions resulting in dry mouth may interfere with nutritional intake, but it is not life threatening. Erythema of the skin may cause dry or wet desquamation, but it is not life threatening. Radiation to the neck area should not produce as significant bone marrow suppression as radiation to the other sites.

A client is to have a parotidectomy to remove a cancerous lesion. Which postoperative complication that may be permanent should the nurse monitor in this client? 1 A tracheostomy 2 Frey syndrome 3 An increase in salivation 4 Facial nerve dysfunction

4 Facial nerve dysfunction The facial nerve may be damaged during surgery. Drooping of the area results from loss of muscle tone. A tracheostomy is not a complication. Frey syndrome is also called auriculotemporal syndrome; it may follow infection and suppuration of the parotid gland and is not a surgical complication. The parotid is a salivary gland; its removal will decrease salivation

A 75-year-old male with a history of cancer of the prostate is admitted for a prostatectomy. The client's prostate specific antigen (PSA) levels have been increasing. This finding should prompt the nurse to include what in the client's plan of care? 1 Measure intake and output. 2 Institute seizure precautions. 3 Monitor the plasma pH for acidosis. 4 Handle the client gently when turning

4 Handle the client gently when turning. Increasingly elevated PSA levels may indicate a worsening of the client's condition with possible metastasis to the bone, increasing the risk of pathologic fractures; therefore handling must be gentle. Although measuring intake and output is necessary for any client with prostatic cancer because of the risk of bladder obstruction, it is not the priority for this client. Seizure precautions are not necessary; a PSA elevation indicates bone, not brain, involvement. Elevated PSA levels do not significantly affect the plasma pH.

A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed? 1 Obesity 2 High-fat diet 3 Hypertension 4 Late-onset menarche

4 Late-onset menarche Early-onset, not late-onset, menarche is a risk factor for endometrial cancer. A high-fat diet, hypertension, and obesity are all risk factors for endometrial cancer.

A primary health care provider prescribes total parenteral nutrition for a client with cancer of the pancreas. A central venous access device is inserted. What does the nurse identify as the most important reason for using this type of access? 1 Infection is uncommon. 2 It permits free use of the hands. 3 The chance of the infusion infiltrating is decreased. 4 The amount of blood in a major vein helps to dilute the solution.

4 The amount of blood in a major vein helps to dilute the solution. Unless diluted, the highly concentrated solution can cause vein irritation or occlusion. Although it permits free use of the hands, this is not the primary reason for a central line. Infection can occur at any invasive site and requires diligent care to avoid this complication. The chance of the infusion infiltration decreasing is not the primary reason, although the infusion at this site is more secure than a peripheral site and promotes free use of the hands.

A client who is in a late stage of pancreatic cancer intellectually understands the terminal nature of the illness. What are behaviors that indicate the client is emotionally accepting the impending death? 1 Revising the client's will and planning a visit to a friend 2 Alternately crying and talking openly about death 3 Getting second, third, and fourth medical opinions 4 Refusing to follow treatments and stating they won't help anyway

1 Revising the client's will and planning a visit to a friend Revising the will and planning a visit to a friend are realistic, productive, and constructive ways of using this time. Crying and talking openly about death are signs of depression. Going from healthcare provider to healthcare provider demonstrates disbelief, denial, or desperation. Refusing to follow treatments and stating that the client is going to die anyway indicates anger and hopelessness, not acceptance.

A 49-year-old client is admitted with a diagnosis of cervical cancer. As the nurse is obtaining her health history, she says, "I haven't had a Pap smear for more than 5 years. I probably wouldn't be in the hospital today if I'd had those tests more often." What is the nurse's most appropriate response? 1 "Please tell me why you waited so long." 2 "You feel as though you've neglected your health." 3 "It's never too late to start taking care of yourself." 4 "Most women hate to have Pap smears done, but they're really important."

2 "You feel as though you've neglected your health." Stating that the client feels that she's neglected her health indicates recognition of expressed feelings; a nondirective and reflective response encourages verbalization. Asking the client why she waited so long ignores the client's current emotional needs; direct statements often do not elicit feelings and may cut off communication. Stating that it is never too late to start taking care of her health is a judgmental response, because it implies that the client has been negligent. Although it is true that most clients hate to have Pap smears, this statement ignores the client's current emotional needs.

A nurse is caring for a client who is scheduled to have an abdominal perineal resection for colorectal cancer. The client has type B negative blood. If a blood infusion is needed, which type is preferred for administration? 1 A positive 2 B negative 3 O negative 4 AB positive

2 B negative B negative is the same as the client's blood type and is preferred; only in an emergency will type O negative blood be given. Irrespective of blood type, Rh-positive blood is incompatible with the client's blood and will cause hemolysis if it is transfused. Although O negative blood can be used in an emergency, it is not the preferred blood type in an elective situation.

A hospital organization plans to conduct a study on the effect of dried plums for lowering the risk of colon cancer. After selecting the subjects, a nurse researcher provides adequate information about the research and then inquires about the preference of the subjects to associate with the research. What does this procedure indicate? 1 Anonymity 2 Informed consent 3 Inductive reasoning 4 Performance improvement

2 Informed consent Informed consent means that the clients who are selected to participate in the study are given full and complete information about the purpose of a study, procedures, potential harm and benefits, and alternative methods of treatment. The clients have the free choice to voluntarily consent or decline participation in the research. Anonymity or confidentiality guarantees that any information provided by the client that identifies him or her will not be reported and will not be accessible to people outside the research team or other authorized users. Qualitative research involves inductive reasoning to develop generalizations or theories from specific observations. In performance improvement (PI), an organization analyzes and evaluates current performance and uses the results to develop focused improvement plans.

A client with cervical cancer is to undergo a course of internal radiation. The client returns to her lead-lined room on the oncology unit with an indwelling urinary catheter and a vaginal applicator in place. Once the primary healthcare provider has loaded the applicator with the radiation source, what should the nurse's plan of care include? 1 Changing linens several times a day 2 Leaving the urinary catheter undisturbed 3 Cleansing the perineal area with a mild antiseptic twice daily 4 Removing equipment from the room immediately after it is used

2 Leaving the urinary catheter undisturbed Preventing the occurrence of complications is a major goal during internal radiation treatment. If the source of radiation is disturbed, injury to the client, as well as the personnel caring for her, may result. Therefore the area surrounding the urinary catheter is not touched or cleansed. Linens are changed only when necessary; linens are kept in the client's room until therapy is complete. As a means of preventing dislodgement of the radiation applicator, the area surrounding the source of internal radiation is not touched or cleansed. Displacement may result in unnecessary tissue damage or exposure of the nurse to radiation. Equipment is usually kept in the client's room until the source of radiation is removed.

A client was treated with methotrexate for cancer during the 6th month of her pregnancy. Which teratogenic effect may be seen in the child? 1 Stillbirth 2 Mental retardation 3 Holoprosencephaly 4 Normal development of the child

2 Mental retardation The fetus is in its fetal stage of development at 6 months of gestation. Methotrexate exposure in the fetal stage of development may cause mental retardation in the baby. Stillbirth may occur if the exposure is during the presomite stage. Holoprosencephaly may occur if the teratogen exposure was in the embryonic stage. Normal development of the child may occur if the exposure occurred during the presomite stage.

A 60-year-old client with gastric cancer has a shiny tongue, paresthesias of the limbs, and ataxia. The laboratory results show cobalamin levels of 125 pg/mL. Which medication would the nurse consider to be a high priority for the client? 1 Oral hydroxyurea 2 Vitamin B 12 injections 3 Oral iron supplements 4 Erythropoietin injection

2 Vitamin B 12 injections A shiny tongue, paresthesias of the limbs, ataxia, and cobalamin of 125 pg/mL (normal: 200- 835 pg/mL) are the manifestations of pernicious anemia. The client has pernicious anemia due to a vitamin B 12 deficiency and should be given vitamin B 12 injections. Vitamin B 12 cannot be given orally to a client with pernicious anemia because the client does not produce the intrinsic factors needed to absorb Vitamin B 12. Hydroxyurea is administered orally to clients with hemochromatosis. Oral iron supplements are given to clients with iron deficiency anemia. Erythropoietin injections are given to clients who have low red blood cells, hemoglobin, and hematocrit.

The nurse is caring for a client in the postanesthesia care unit. The client had a suprapubic prostatectomy for cancer of the prostate and has a continuous bladder irrigation (CBI) in place. Which primary goal is the nurse trying to achieve with the CBI? 1 Stimulate continuous formation of urine. 2 Facilitate the measurement of urinary output. 3 Prevent the development of clots in the bladder. 4 Provide continuous pressure on the prostatic fossa.

3 Prevent the development of clots in the bladder. A continuous flushing of the bladder dilutes the bloody urine and empties the bladder, preventing clots. Fluid instilled into the bladder does not affect kidney function. Urinary output can be measured regardless of the amount of fluid instilled. The urinary retention catheter is not designed to exert pressure on the prostatic fossa.

A nurse is teaching an adult health and wellness class about bladder cancer. Which activities should the nurse include in the teaching session that increase risk? Select all that apply. 1 Jogging 3 miles (4.8 km) a day 2 Drinking three cans of cola a day 3 Smoking two packs of cigarettes a day 4 Working with dyes used in rubber every day 5 Using a jackhammer and chainsaw every day

3, 4 The occurrence of bladder cancer [1] [2] is related to smoking. Dyes in rubber and hair dyes are environmental carcinogens; working with them daily increases an individual's risk of bladder cancer. Jogging is unrelated to the development of cancer of the bladder. Ingestion of cola has not been linked to cancer of the bladder. Vibrations may result in musculoskeletal or kidney problems but are unrelated to cancer of the bladder.

A client is admitted to the hospital with a diagnosis of cancer of the liver with ascites and is scheduled for a paracentesis. Which nursing intervention is appropriate to include in the client's plan of care? 1 Cleansing the intestinal tract 2 Marking the anesthetic insertion site 3 Discussing the operating room set-up 4 Having the client void before the procedure

4 Having the client void before the procedure Because the trocar is inserted below the umbilicus, having the client void decreases the danger of puncturing the bladder. Cleansing the intestinal tract is not necessary because the gastrointestinal tract is not involved in a paracentesis. The primary healthcare provider, not the nurse, uses a local anesthetic to block pain during the insertion of the aspirating needle; marking the site usually is not done. A paracentesis usually is performed in a treatment room or at the client's bedside, not in the operating room.