MEDSURG II: Saunders Medsurg Oncology

The nurse has provided instructions to a client receiving external radiation therapy. Which client statement would indicate a need for further instruction regarding self-care related to the radiation therapy? 1. "I need to eat a high-protein diet." 2. "I need to avoid exposure to sunlight." 3. "I need to wash my skin with a mild soap and pat dry." 4. "I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding."

4. "I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding." Rationale: The client should avoid pressure on the irritated area and should wear loose-fitting clothing. Specific health care provider instructions would be necessary if an alteration in skin integrity occurred as a result of the radiation therapy. Options 1, 2, and 3 are accurate measures to implement after radiation therapy.

The oncology nurse is providing a teaching session for a group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student would indicate a need for further teaching? 1. "Bladder cancer most often occurs in women." 2. "Using cigarettes and drinking coffee can increase the risk." 3. "Bladder cancer generally is seen in clients older than age 40." 4. "Environmental health hazards have been implicated as a cause."

Answer: 1. "Bladder cancer most often occurs in women." Rationale: The incidence of bladder cancer is greater in men than in women and affects white people twice as often as black people. The remaining options describe risks associated with bladder cancer.

The nurse has provided discharge instructions to a client who underwent a right mastectomy with axillary lymph node dissection. Which statement made by the client indicates a need for further instruction regarding home care measures? 1. "It is all right to use a straight razor to shave under my arms." 2. "I must be sure to use thick potholders when I am cooking." 3. "I must be sure not to have blood pressures taken or blood drawn from my right arm." 4. "I should inform all of my other health care providers that I have had this surgical procedure."

Answer: 1. "It is all right to use a straight razor to shave under my arms." Rationale: After mastectomy with axillary lymph node dissection, the client is at risk for arm edema and infection. The client should be instructed regarding home care measures to prevent these complications. The client should be told to avoid activities such as carrying heavy objects or having blood pressure measurements taken on the affected arm. The client also should be instructed in the techniques to avoid trauma to the affected arm, such as using an electric razor to shave under the arms, using gloves when working in the garden, and using or wearing thick potholders when cooking.

The nurse is performing a skin assessment on a client diagnosed with malignant melanoma. The nurse should expect to note which characteristic of this type of skin lesion? 1. An irregularly shaped lesion 2. A small papule with a dry, rough scale 3. A firm nodular lesion topped with crust 4. A pearly papule with a central crater and a waxy border

Answer: 1. An irregularly shaped lesion Rationale: A melanoma is an irregularly shaped pigmented papule or plaque with a red, white, or blue tone. Actinic keratosis, a premalignant lesion, appears as a small macule or papule with a dry, rough adherent yellow or brown scale. Squamous cell carcinoma is a firm nodular lesion topped with a crust or a central area of ulceration. Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border.

The nurse is reviewing the laboratory test results for a client with bladder cancer with bone metastasis. The nurse should contact the health care provider (HCP) if which finding is noted? 1. Calcium level of 15 mg/dL (3.75 mmol/L) 2. Potassium level of 3.8 mEq/L (3.8 mmol/L) 3. Platelet count of 200,000 mm3 (200 × 109/L) 4. White blood cell (WBC) count of 6000 mm3 (6 × 109/L)

Answer: 1. Calcium level of 15 mg/dL (3.75 mmol/L) Rationale: Hypercalcemia is a serum calcium level greater than 10.5 mg/dL (2.6 mmol/L). It most often occurs in clients who have bone metastasis and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. Hypercalcemia is an oncological emergency, and the HCP needs to be notified. Options 2, 3, and 4 indicate normal laboratory values.

A client is admitted to the nursing unit after undergoing radical prostatectomy for cancer. The nurse anticipates that which problem would be of most concern to the client in the immediate postoperative period? 1. Concern about the outcome of surgery 2. Continuous pain because of the effects of cancer 3. Appearance disturbance as a result of the presence of a suprapubic catheter 4. Concern about caring for self at home because of insufficient help after discharge

Answer: 1. Concern about the outcome of surgery Rationale: In the immediate postoperative period, the client who has had surgery for cancer may experience fear or concern related to the uncertain outcome of surgery. Postoperative pain is classified as acute, not continuous. The client may experience an alteration in appearance, but this is more likely to be related to the anticipated change in sexual function than the presence of the suprapubic catheter. The priority focus in the immediate postoperative period is not on concerns that apply to hospital discharge.

The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count

Answer: 1. Encouraging fluids Rationale: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client.

A woman has just been told by the health care provider that she has breast cancer. The woman responds, "Oh, no! Does this mean I'm going to die?" The nurse interprets the woman's initial reaction as which response? 1. Fear 2. Rage 3. Denial 4. Anxiety

Answer: 1. Fear Rationale: The woman's reaction is one of fear. The woman has verbalized the object of fear (dying), which makes anxiety incorrect. There is no evidence of rage or denial in the woman's statement.

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4. Decreased number of plasma cells in the bone marrow

Answer: 1. Increased calcium level Rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.

A client with liver cancer who is receiving chemotherapy tells the nurse that some foods taste bitter. The nurse would try to limit which food that is most likely to cause this bitter taste for the client? 1. Pork 2. Custard 3. Potatoes 4. Cantaloupe

Answer: 1. Pork Rationale: Chemotherapy may cause distortion of taste. Frequently, beef and pork are reported to taste bitter or rancid. The nurse can promote client nutrition by helping the client choose alternative sources of protein in the diet, such as mild-tasting fish, cold chicken, turkey, eggs, or cheese. Custard, potatoes, and cantaloupe are not likely to cause distortion of taste.

The home health care nurse is visiting a client who has undergone a mastectomy. The nurse determines that the client demonstrates greatest adjustment to the loss of the breast if which behavior is noted? 1. The client looks at the surgical site. 2. The client performs the prescribed arm exercises. 3. The client takes the pain medication as prescribed. 4. The client has read all of the postoperative materials provided by the hospital nurse.

Answer: 1. The client looks at the surgical site. Rationale: Of the options provided, the client behavior in the correct option demonstrates the greatest adaptation or adjustment (looking at the surgical site). This indicates that the client has acknowledged and is beginning to cope with the loss of the breast. Reading postoperative care booklets and performing prescribed exercises indicate an interest in self-care and are positive signs indicating adjustment. Taking pain medication is not related to adjustment to the loss of the breast.

The nurse is caring for a client with leukemia. In assessing the client for signs of leukemia, the nurse determines that what should be monitored? 1. Platelet count 2. Bone marrow biopsy 3. White blood cell count 4. Complete blood cell count

Answer: 2. Bone marrow biopsy Rationale: Bone marrow aspiration or biopsy allows examination of blast cells and other hypercellular activity. Blood studies will not provide a definitive diagnosis of leukemia.

The nurse has conducted a cancer prevention seminar for clients in an ambulatory setting. The nurse determines that teaching was effective if the clients select which food item on the menu? 1. Broiled beef, canned corn, rice 2. Broccoli, baked fish, mashed potato 3. Bacon, scrambled eggs, french fries 4. Bologna, canned asparagus, white bread

Answer: 2. Broccoli, baked fish, mashed potato Rationale: Broccoli is a cruciferous vegetable, which is helpful in reducing the risk of cancer. Other cruciferous vegetables are cauliflower, Brussels sprouts, and cabbage. Red meat (bacon) and meats with nitrites (bologna and broiled beef) can increase the risk of developing cancer.

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1. Placing cool compresses on the affected arm 2. Elevating the affected arm on a pillow above heart level 3. Avoiding arm exercises in the immediate postoperative period 4. Maintaining an intravenous site below the antecubital area on the affected side

Answer: 2. Elevating the affected arm on a pillow above heart level Rationale: Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.

For the client with stomatitis resulting from chemotherapy, the care plan should include which intervention? 1. Inspect the mouth every week for fungus. 2. Encourage foods with neutral or cool temperatures. 3. Give the client spicy foods to stimulate the sense of taste. 4. Perform frequent oral hygiene using a commercial alcohol-based mouthwash.

Answer: 2. Encourage foods with neutral or cool temperatures. Rationale: Stomatitis is inflammation of the oral cavity, and using commercial mouthwashes containing alcohol or encouraging spicy foods will cause pain. Foods are better tolerated by the client with stomatitis when the food is cool or of neutral temperature. It is important to monitor for oral fungal infections, but this assessment should be completed at least daily.

A client is admitted to the hospital with suspected bladder cancer. The nurse assesses the client for which early signs and symptoms of the disease? 1. Proteinuria and dysuria 2. Hematuria and absence of pain 3. Painful urination and hematuria 4. Pyuria and palpable abdominal mass

Answer: 2. Hematuria and absence of pain Rationale: The most common earliest manifestation of bladder cancer is hematuria that is not accompanied by pain {PAINLESS Hematuria}. The hematuria is intermittent at first. Later signs and symptoms include hematuria with dysuria and frequency because of bladder irritation. Pyuria and proteinuria are not part of the clinical picture. A mass usually is not palpable.

The nurse is caring for a client with leukemia who is receiving intravenous chemotherapy. The nurse reviews the laboratory results and notes that the white blood cell count is 2000 mm3 (2 × 109/L), the platelet count is 150,000 mm3 (150 × 109/L), the clotting time is 10 minutes, and the ammonia level is 20 mcg/dL (12 mcmol/L). Which nursing action would be appropriate? 1. Place the client on bleeding precautions. 2. Place the client on neutropenic precautions. 3. Remove the rectal thermometer from the client's room. 4. Instruct the dietary department to eliminate all proteins from the client's diet.

Answer: 2. Place the client on neutropenic precautions. Rationale: The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). When the white blood cell count drops, neutropenic precautions need to be implemented. This includes protective isolation techniques to protect the client from infection. Bleeding precautions need to be initiated when the platelet count drops below 90,000 to 100,000 mm3 (90 to 100 × 109/L) or per health care provider prescription or agency policy. The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal clotting time is 8 to 15 minutes, and the normal ammonia level is 10 to 80 mcg/dL (6 to 47 mcmol/L). Removing the rectal thermometer from the client's room would be done if bleeding precautions were initiated. There is no useful reason to eliminate all protein from the diet.

The nurse monitoring an oncological client assesses for which early sign of vena cava syndrome? 1. Cyanosis 2. Arm edema 3. Periorbital edema 4. Mental status changes

Answer: 3. Periorbital edema Rationale: Vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs.

The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse should prepare to implement which action based on this finding? 1. Remove the fresh flowers from the client's room. 2. Remove the rectal thermometer from the client's room. 3. Instruct family members to wear a mask when entering the client's room. 4. Call the dietary department to report that the client will be on a low-bacteria diet.

Answer: 2. Remove the rectal thermometer from the client's room. Rationale: When the client's platelet count is low, the client is at risk for bleeding. Options 1, 3, and 4 relate to the risk for infection. Rectal temperatures should not be taken on a client who is at risk for bleeding because the thermometer could cause an alteration in the delicate rectal membranes and lead to bleeding.

The nurse is preparing to care for a client with a diagnosis of metastatic cancer. The nurse notes documentation in the client's chart that the client is experiencing cachexia. Which should the nurse expect to note on assessment of the client? 1. Elevated blood pressure and ascites 2. Sunken eyes and a hollow cheek appearance 3. Periorbital edema and swelling around the ears 4. Generalized edema and the presence of weight gain

Answer: 2. Sunken eyes and a hollow cheek appearance Rationale: Cachexia accompanies chronic wasting diseases and conditions such as cancer, dehydration, and starvation. Assessment findings in a client with cachexia include sunken eyes; hollow cheeks; and an exhausted, defeated expression. Options 1, 3, and 4 are not characteristic of a cachectic appearance.

The community health nurse is preparing an educational session for a group of women and will be discussing the primary prevention strategies and treatment measures for breast cancer. What information should the nurse include in the educational session? 1. Older women are more likely to get mammograms. 2. Treatment decisions are based on a woman's overall health. 3. Women younger than age 65 are more likely to get breast cancer. 4. A woman's age is the main factor used to decide which screening methods to use.

Answer: 2. Treatment decisions are based on a woman's overall health. Rationale: Breast cancer occurs most often in women who are 65 years of age or older, and older women are less likely to have mammograms. Rather than using the woman's age to decide on screening and treatment measures, the woman's overall health is used to make these determinations, since health status has a greater influence on tolerance to treatment.

A client calls the ambulatory care clinic and tells the nurse that she found an area that looks like the peel of an orange when performing breast self-examination (BSE) but found no other changes. What is the nurse's best response to this client? 1. "Good job performing your BSE. I am sure that is nothing to be concerned about." 2. "Make sure you tell the health care provider about your finding at the next regularly scheduled visit." 3. "I am glad you called to report this finding. Can you come to the clinic to see your health care provider tomorrow?" 4. "Do you have a thermometer? You need to take your temperature and call back if you have a fever over 101°F/38.3°C."

Answer: 3. "I am glad you called to report this finding. Can you come to the clinic to see your health care provider tomorrow?" Rationale: Peau d'orange or orange peel appearance of the skin over the breast is associated with late breast cancer. Therefore, the nurse would arrange for the client to come to the clinic as soon as possible. Peau d'orange is not indicative of an infection.

The nurse is providing instructions to the client who is receiving external radiation therapy. Which statement, if made by the client, indicates the need for further instruction? 1. "I will dry affected areas with patting motions." 2. "I will wear soft clothing over the affected site." 3. "I will use a washcloth to wash the affected area." 4. "I need to make sure I carry my purse on the unaffected side."

Answer: 3. "I will use a washcloth to wash the affected area." Rationale: External radiation therapy requires that markings be placed on the skin so that therapy can be aimed at the affected areas. The hand rather than a washcloth should be used to wash the area to avoid irritation. The nurse should instruct the client who is undergoing external radiation therapy to dry affected areas with a patting (rather than rubbing) motion so as not to disrupt the markings on the skin. Soft clothing should be worn so that the affected area is not irritated. The client should be sure to carry her purse on the unaffected side.

As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? 1. "I should avoid blowing my nose." 2. "I may need a platelet transfusion if my platelet count is too low." 3. "I'm going to take aspirin for my headache as soon as I get home." 4. "I will count the number of pads and tampons I use when menstruating."

Answer: 3. "I'm going to take aspirin for my headache as soon as I get home." Rationale: During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells mm3 (20.0 × 109/L). The correct option describes an incorrect statement by the client. Aspirin and nonsteroidal antiinflammatory drugs and products that contain aspirin should be avoided because of their antiplatelet activity. Options 1, 2, and 4 are correct statements by the client to prevent and monitor bleeding.

The nurse conducted discharge teaching for the client diagnosed with melanoma. Which statement by a client indicates that education was effective? 1. "It is contagious." 2. "Metastasis is rare." 3. "It is highly metastatic." 4. "It is characterized by local invasion."

Answer: 3. "It is highly metastatic." Rationale: Melanomas are pigmented malignant lesions originating in the melanin-producing cells of the epidermis. This skin cancer is highly metastatic, and the affected person's survival depends on early diagnosis and treatment. It is not a contagious lesion. Basal cell carcinomas arise in the basal cell layer of the epidermis. Early malignant basal cell lesions often go unnoticed, and although metastasis is rare, underlying tissue destruction can progress to include vital structures. Squamous cell carcinomas are malignant neoplasms of the epidermis. They are characterized by local invasion and the potential for metastasis.

A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? 1. Fatigue 2. Weakness 3. Weight gain 4. Enlarged lymph nodes

Answer: 4. Enlarged lymph nodes Rationale: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

The nurse is caring for a client undergoing external radiation. The client has developed a dry desquamation of the skin in the treatment area, and the nurse is teaching about management of the skin reaction. Which comment made by the client suggests understanding of the instructions? 1. "I don't need to stay out of the sun or put on sunscreen." 2. "I can use ice packs to relieve itching in the treatment area." 3. "When bathing I will use lukewarm water on the affected area." 4. "I can lubricate the irritated area with an ointment like bacitracin."

Answer: 3. "When bathing I will use lukewarm water on the affected area." Rationale: Radiation therapy causes skin cells to break down and die. This can cause a disruption in skin integrity. The client needs to use special and gentle skin care during treatment. This means washing with lukewarm water and not rubbing skin. The client will need to protect the skin from the sun even after radiation therapy is completed. The sun can burn the skin even on cloudy days or when the client is outside even for just a few minutes. The health care provider (HCP) may prescribe a high sun protection factor sunscreen. Care should be taken to not use extreme water temperatures, heating pads, ice packs, or other hot or cold items on the treatment area; these items can disrupt skin integrity. No products (creams, lotions, ointments, perfumes) should be used on the skin during radiation without approval of the HCP.

The nurse is caring for a client with metastatic breast cancer. The client describes a new and sudden sharp pain in the back. Based on this assessment finding, which is the priority nursing intervention? 1. Document the findings. 2. Administer pain medication. 3. Notify the health care provider (HCP). 4. Place a heating pad on the client's back.

Answer: 3. Notify the health care provider (HCP). Rationale: Spinal cord compression should be suspected in a client with metastatic disease, particularly with sudden onset of new back pain. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression constitutes an oncological emergency, so the HCP should be notified. Although the nurse would document this finding, this is not the priority action. The nurse would not administer pain medication or place a heating pad on the client unless the cause of the new pain has been determined. In addition, a prescription from the HCP is needed for the use of a heating pad.

The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? 1. Cyanosis 2. Arm edema 3. Periorbital edema 4. Mental status changes

Answer: 3. Periorbital edema Rationale: Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental status changes are late signs.

The nurse in the health care provider's office is performing a postoperative assessment of a client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should provide which information to the client about her complaint? 1. These sensations are signs of a complication. 2. These sensations probably will be permanent. 3. These sensations dissipate over several months and usually resolve after 1 year. 4. It is nothing to worry about because most women who have this type of surgery experience this problem.

Answer: 3. These sensations dissipate over several months and usually resolve after 1 year. Rationale: Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow occurs in most women after mastectomy. It is a result of injury to the nerves that provide sensation to the skin in those areas. These sensations may be described as heaviness, pain, tingling, burning, or "pins and needles." These sensations dissipate over several months and usually resolve by 1 year after surgery. These sensations are not a sign of a complication and are not permanent. The nurse would not tell the client that a complaint is nothing to worry about because this is nontherapeutic and avoids the client's concern.

The nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. The nurse should teach the client to put the pillow in which location for self-examination of the right breast? 1. Under the left scapula 2. Under the left shoulder 3. Under the right shoulder 4. Under the small of the back

Answer: 3. Under the right shoulder Rationale: The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder, and vice versa. Therefore, options 1, 2, and 4 are incorrect.

The nurse teaches skin care to a client receiving external radiation therapy. Which client statement indicates the need for further instruction? 1. "I will handle the area gently." 2. "I will wear loose-fitting clothing." 3. "I will avoid the use of deodorants." 4. "I will limit sun exposure to 1 hour daily."

Answer: 4. "I will limit sun exposure to 1 hour daily." Rationale: The client needs to be instructed to avoid exposure to the sun. Because of the risk of altered skin integrity, options 1, 2, and 3 are accurate measures in the care of a client receiving external radiation therapy.

The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency? 1. Headache 2. Dysphagia 3. Constipation 4. Electrocardiographic changes

Answer: 4. Electrocardiographic changes Rationale: Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.

A client with leukemia is receiving busulfan and allopurinol (chemotherapy agents) {Note: busulfan is a chemotherapy medication; however, allopurinol is NOT}. The nurse should tell the client that the purpose of the allopurinol is to prevent which symptom? 1. Nausea 2. Alopecia 3. Vomiting 4. Hyperuricemia

Answer: 4. Hyperuricemia Rationale: Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increase as a result of the massive cell destruction that occurs because of the chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy. Allopurinol is not used to prevent alopecia, nausea, or vomiting.

The nurse is providing care to a client who has undergone modified right mastectomy for the treatment of breast cancer. Which activity should the nurse incorporate into the plan of care? 1. Keep suction drains fully inflated to provide adequate suction. 2. Perform venipunctures and blood pressures on the operative side only. 3. Inform the client that drains will be removed on the second postoperative day. 4. Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow.

Answer: 4. Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow. Rationale: The client should have the head of the bed elevated at least 30 degrees with the affected arm elevated on a pillow. Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. Gentle suction must be maintained on the drain bulb to prevent fluid accumulation at the operative site. With short hospital stays, drainage tubes are usually removed about 1 to 3 weeks after hospital discharge when the client returns for an office visit. All staff must avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood.

The client has undergone mastectomy. The nurse determines that the client is making the best adjustment to the loss of the breast if which behavior is observed? 1. Refusing to look at the wound 2. Reading the postoperative care booklet 3. Asking for pain medication when needed 4. Participating in the care of the surgical drain

Answer: 4. Participating in the care of the surgical drain Rationale: The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that are in place for a short time after discharge. Refusing to look at the wound indicates no adaptation to the loss. Reading the postoperative care booklet is useful but is not the best of the options presented here. Asking for pain medication is an action-oriented option, but it does not relate to acceptance of the loss of the breast.

The home care nurse visits a client who has just returned home from the hospital after a mastectomy with a suction drain in place. Which observed client behavior requires a need for further teaching? 1. Empties the drain to prevent infection 2. Elevates the arm when lying and sitting 3. Applies lotion to the area after the incision heals 4. Performs full range-of-motion exercises to the upper arm

Answer: 4. Performs full range-of-motion exercises to the upper arm Rationale: The client should be instructed to limit upper arm range-of-motion exercises to the level of the shoulder only. Once the suction drain has been removed, the client can begin full range-of-motion exercises to the upper arm as prescribed. The client should elevate the arm while sitting down or lying, and the client will be able to apply lotion to the incision once it has healed. The drain is emptied as needed.

The oncology nurse specialist provides an educational session for nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which is a characteristic of the disease? 1. Reed-Sternberg cells are present. 2. The lymph nodes, spleen, and liver are involved. 3. The prognosis depends on the stage of the disease. 4. The disease occurs most often in those older than 75 years of age.

Answer: 4. The disease occurs most often in those older than 75 years of age. Rationale: Hodgkin's lymphoma is a cancer that can occur at any age but appears to peak in 2 different age groups: in teens and young adults and in adults in their 50s and 60s. The remaining options are characteristics of this disease.

A client receiving chemotherapy is experiencing mucositis. The nurse should advise the client to use which item as the best substance to rinse the mouth? 1. Alcohol-based mouthwash 2. Hydrogen peroxide mixture 3. Lemon-flavored mouthwash 4. Weak salt and bicarbonate mouth rinse

Answer: 4. Weak salt and bicarbonate mouth rinse Rationale: An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of the presence of severe plaque, it should be a weak solution, because hydrogen peroxide dries the mucous membranes.

The nurse has admitted a client to the clinical nursing unit after undergoing a right mastectomy. The nurse should plan to place the right arm in which position? 1. Elevated on a pillow 2. Level with the right atrium 3. Dependent to the right atrium 4. Elevated above shoulder level

Answer: Elevated on a pillow Rationale: The client's operative arm should be positioned so that it is elevated on a pillow and not exceeding shoulder elevation. This position promotes optimal drainage from the limb, without impairing the circulation to the arm. If the arm is positioned flat (option 2) or dependent (option 3), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery.

A client who is receiving chemotherapy for breast cancer develops myelosuppression. Which instructions should the nurse include in the client's discharge teaching plan? Select all that apply. 1. Avoid contact sports. 2. Wash hands frequently. 3. Increase intake of fresh fruits and vegetables. 4. Avoid crowded places such as shopping malls. 5. Treat a sore throat with over-the-counter products. 6. Avoid people who have received live attenuated vaccines.

Answers: 1. Avoid contact sports. 2. Wash hands frequently. 4. Avoid crowded places such as shopping malls. 6. Avoid people who have received live attenuated vaccines. Rationale: Effective measures should be used to protect the client from infection and bleeding. A variety of interventions are essential to keep the client who is receiving chemotherapy safe. Live attenuated vaccines can easily infect clients with myelosuppression, and crowded places usually have people who are sick and coughing and sneezing, which can easily cause illness in myelosuppressed clients. Contact sports can result in injury or bleeding, and hand washing is the mainstay of asepsis and protection from infection. The client with myelosuppression should not eat fresh fruits and vegetables because of the risk of contamination or infection. All foods should be thoroughly cooked. Option 5 is incorrect because many over-the-counter products contain acetaminophen or aspirin, which could potentially mask an elevated temperature. Additionally, aspirin is an antiplatelet and can cause bleeding. Clients receiving chemotherapy should not take any other medications without direction from the health care provider.

A client with bladder cancer has undergone surgical removal of the bladder with creation of an ileal conduit. Which assessment findings indicate that the client is developing complications? Select all that apply. 1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity 4. Urine output greater than 30 mL/hour 5. Mucus shreds in the urine collection bag

Answers: 1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity Rationale: To create an ileal conduit, the surgeon takes a short segment of the small intestine and reconnects the remaining intestine so that it functions normally. One end of the removed segment of intestine is placed at the skin surface to create the stoma. The stoma should be red and moist. A pale, dusky stoma indicates poor vascular supply that could result in necrosis. The stoma should be flush to the skin. The client should not have sharp abdominal pain with rigidity, an indication of peritonitis. Any of these findings should be reported to the health care provider. Options 4 and 5 are normal findings.

The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply. 1. Facial edema in the morning 2. Weight loss of 20 lb (9 kg) in 1 month 3. Serum calcium level of 12 mg/dL (3.0 mmol/L) 4. Serum sodium level of 136 mg/dL (136 mmol/L) 5. Serum potassium level of 3.4 mg/dL (3.4 mmol/L) 6. Numbness and tingling of the lower extremities

Answers: 1. Facial edema in the morning 3. Serum calcium level of 12 mg/dL (3.0 mmol/L) 6. Numbness and tingling of the lower extremities Rationale: Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12 mg/dL (3.0 mmol/L) indicates hypercalcemia. Numbness and tingling of the lower extremities could be a sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium level of 136 mg/dL (136 mmol/L) is a normal level.

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of Hodgkin's disease. Which assessment findings noted in the client's record are associated with this diagnosis? Select all that apply. 1. Fever 2. Weight loss 3. Night sweats 4. Visual changes 5. Enlarged, painless lymph nodes

Answers: 1. Fever 2. Weight loss 3. Night sweats 5. Enlarged, painless lymph nodes Rationale: Assessment of a client with Hodgkin's disease most often reveals enlarged, painless lymph nodes along with fever, malaise, and night sweats. Weight loss may be a feature in metastatic disease. Visual changes are not specifically associated with Hodgkin's disease.

The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings should the nurse expect to note? Select all that apply. 1. Pathological fracture 2. Urinalysis positive for nitrites 3. Hemoglobin level of 15.5 g/dL (155 mmol/L) 4. Calcium level of 8.6 mg/dL (2.15 mmol/L) 5. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L)

Answers: 1. Pathological fracture 2. Urinalysis positive for nitrites 5. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L) Rationale: Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. The client with malignant melanoma may experience pathologic fractures, hypercalcemia, anemia, recurrent infections, and renal failure. A serum calcium level of 8.6 mg/dL (2.15 mmol/L) and a hemoglobin level of 15.5 g/dL (155 mmol/L) are normal values. Therefore, the correct answers are pathological fractures, positive urinalysis for nitrites, and a serum creatinine level of 2.0 mg/dL (176.6 mcmol/L).

A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? Select all that apply. 1. Radiation 2. Chemotherapy 3. Increased fluid intake 4. Decreased oral sodium intake 5. Serum sodium level determination 6. Medication that is antagonistic to antidiuretic hormone

Answers: 1. Radiation 2. Chemotherapy 5. Serum sodium level determination 6. Medication that is antagonistic to antidiuretic hormone Rationale: Cancer is a common cause of SIADH. In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

A client with a medical diagnosis of breast cancer is undergoing chemotherapy. The client complains to the nurse about losing her hair and severe fatigue from the treatment. Which interventions should the nurse implement for this client? Select all that apply. 1. Review side effects of chemotherapy and treatment with the client. 2. Teach the client how to resolve specific concerns of her personal life. 3. Teach the client to pace activities with rest so as to maintain strength. 4. Offer information on available counseling services and support groups. 5. Tell the client about some other clients who have had breast cancer treatment. 6. Inquire how the cancer diagnosis and treatment affect the client's normal routine.

Answers: 1. Review side effects of chemotherapy and treatment with the client. 3. Teach the client to pace activities with rest so as to maintain strength. 4. Offer information on available counseling services and support groups. 6. Inquire how the cancer diagnosis and treatment affect the client's normal routine. Rationale: It is not therapeutic nor is it the nurse's role to teach the client how to resolve specific concerns of her personal life. The nurse should determine how the cancer diagnosis and treatment are affecting the client's normal routine, and the client should be aware of potential side effects of treatment so as to cope with the events with medications or other measures.It is important for the nurse to inform clients about support groups available (i.e., Reach for Recovery) so the client does not feel isolated. Teaching clients to pace activities even when they feel well will conserve energy so they ultimately feel stronger and less fatigued. It is a breach of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA) laws for the nurse to discuss other clients and their medical problems.

The community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster? Select all that apply. 1. Multiparity 2. Early menarche 3. Early menopause 4. Family history of breast cancer 5. High-dose radiation exposure to chest 6. Previous cancer of the breast, uterus, or ovaries

Answers: 2. Early menarche 4. Family history of breast cancer 5. High-dose radiation exposure to chest 6. Previous cancer of the breast, uterus, or ovaries Rationale: Risk factors for breast cancer include nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries. In addition, specific inherited mutations in BReast CAncer (BRCA)1 and BRCA2 increase the risk of female breast cancer; these mutations are also associated with an increased risk for ovarian cancer.

The nurse is reviewing the laboratory test results for a client receiving chemotherapy. The nurse notes that the white blood cell count is extremely low and places the client on neutropenic precautions. Which interventions are components of these types of precautions? Select all that apply. 1. Allowing only fresh fruits in the client's room 2. Removing fresh-cut flowers from the client's room 3. Encouraging the client to eat any types of fresh vegetables 4. Instructing family members on the proper technique for hand washing 5. Instructing family members to wear a mask when entering the client's room

Answers: 2. Removing fresh-cut flowers from the client's room 4. Instructing family members on the proper technique for hand washing 5. Instructing family members to wear a mask when entering the client's room Rationale: In the immunocompromised client, a low-bacteria diet is necessary. This includes avoiding the intake of fresh fruits and vegetables. Thorough cooking of all food also is required. Cut flowers and any standing water are removed from the room because both tend to harbor bacteria. Anyone who enters the client's room should perform strict and thorough hand washing and wear a mask.

The nurse is teaching a group of adults about the warning signs of cancer. Which signs and symptoms should the nurse mention to the group? Select all that apply. 1. Areas of alopecia 2. Sores that do not heal 3. Nagging cough or hoarseness 4. Indigestion or difficulty swallowing 5. Change in bowel or bladder habits 6. Absence or decreased frequency of menses

Answers: 2. Sores that do not heal 3. Nagging cough or hoarseness 4. Indigestion or difficulty swallowing 5. Change in bowel or bladder habits Rationale: Cancer is a neoplastic disorder that can involve all body systems. In cancer, cells lose their normal growth-controlling mechanism. Some signs and symptoms include sores that do not heal, a nagging cough or hoarseness, indigestion or difficulty swallowing, and a change in bowel or bladder habits. Areas of alopecia occur following cancer chemotherapy. Absence of menses is not a specific sign; however, abnormal occurrence of menses may be.

A client with laryngeal cancer has undergone laryngectomy and is now receiving external radiation therapy to the head and neck. The nurse should monitor the client for which side and adverse effects of external radiation? Select all that apply. 1. Cystitis 2. Stomatitis 3. Dysgeusia 4. Leukopenia 5. Xerostomia 6. Thrombocytopenia

Answers: 2. Stomatitis 3. Dysgeusia 5. Xerostomia Rationale: Stomatitis (inflammation of the mucous lining in the mouth), dysgeusia (distorted sense of taste), and xerostomia (dry mouth) are local effects of external radiation to the head and neck. Options 4 and 6 are systemic effects and would most likely occur if radiation were applied to areas around the bone marrow. Option 1 is unrelated to the client's condition.

Which interventions are the most appropriate for a client who is experiencing thrombocytopenia? Select all that apply. 1. Use a straight-edge razor for shaving. 2. Obtain a rectal temperature every 8 hours. 3. Check secretions for frank or occult blood. 4. Give vitamin K by the intramuscular route. 5. Encourage fluid intake to avoid constipation. 6. Provide oral sponges or a soft toothbrush for oral care.

Answers: 3. Check secretions for frank or occult blood. 5. Encourage fluid intake to avoid constipation. 6. Provide oral sponges or a soft toothbrush for oral care. Rationale: Thrombocytopenia is a condition in which the platelets fall below the number needed for normal coagulation. When a client has thrombocytopenia, the risk of bleeding is greatly increased. To monitor for bleeding, the nurse should check all secretions for frank or occult blood. Valsalva maneuvers (as in straining to have a stool, vomiting, or sneezing) could cause intracerebral bleeding when the platelet count is low. To avoid constipation, the nurse would encourage the client to take more fluids and increase his or her dietary fiber. The nurse should encourage the client to use a soft toothbrush or oral sponges to decrease irritation to the mouth and bleeding from the gums. An electric razor is recommended for shaving during times when the client is thrombocytopenic. The nurse should not take rectal temperatures or use any rectal suppositories because of the risk for injury to the rectal membranes with resultant bleeding. Medications should not be given subcutaneously or intramuscularly because use of these routes carries a risk for hemorrhage into the tissues.

A 67-year-old man is receiving outpatient radiation treatments for carcinoma of the oropharynx and has developed dysphagia. The nurse develops a teaching plan regarding dysphagia and includes which interventions in the plan? Select all that apply. 1. Teach the man to speak slowly. 2. Teach the man to enunciate clearly. 3. Encourage the man to drink only thin liquids. 4. Teach the man to examine his oral mucosa daily. 5. Encourage the man to use artificial saliva to manage dryness.

Answers: 4. Teach the man to examine his oral mucosa daily. 5. Encourage the man to use artificial saliva to manage dryness. Rationale: Epithelial cells of the head and neck are destroyed by radiation. Examining the oral mucosa is a preventive intervention so that changes in the mucosa will be noted immediately. Inflammation and ulceration also occur because of rapid cell destruction, thereby impairing normal saliva excretion and distribution. Artificial saliva aids in preventing further damage by lubricating the affected area. The client with dysphagia has difficulty swallowing, not difficulty speaking; therefore, teaching him to speak slowly and enunciate clearly will provide no health benefit for his impairment in swallowing. A client with difficulty swallowing should avoid drinking thin liquids because of the increased risk of aspiration owing to epiglottis dysfunction related to radiation therapy.