Nursing 202 Exam 2 Questions

An adolescent is receiving chemotherapy for lymphoma. Which statement by the adolescent supports a nursing diagnosis of Deficient knowledge related to mouth care? A. "I use a soft toothbrush to clean my teeth." B. "I remove white patches from my tongue and cheeks with my toothbrush." C. "I rinse my mouth every 2 to 4 hours with a solution of baking soda and water." D. "I don't use commercial mouthwashes."

B. "I remove white patches from my tongue and cheeks with my toothbrush." White patches on the tongue and oral mucosa indicate infection; the adolescent should report the patches, not remove them. Using a soft toothbrush is appropriate because it prevents injury to the fragile oral mucosa. Rinsing the mouth every 2 to 4 hours with a nonirritating solution, such as baking soda and water or normal saline solution helps prevent stomatitis. Avoiding commercial mouthwashes is appropriate because they may contain alcohol, which may dry the oral mucosa.

A nurse is caring for a client receiving radiation for Hodgkin's lymphoma who begins to exhibit confusion. Upon further assessment, the nurse notes that the client has warm, flushed, dry skin; a heart rate of 110 beats per minute; and a temperature of 101.8° F (38.8° C). Which is the nurse's next best action? A. Call a code. B. Notify the healthcare provider. C. Perform a thorough neurological exam. D. Place the client in a high Fowler's position.

B. Notify the healthcare provider. The client is exhibiting signs and symptoms of sepsis and must be treated immediately. A neurological exam is not warranted and is time consuming at this point. A code is not necessary, as there is no indication that the client is pulseless or not breathing. The high Fowler's position will not change the outcome.

he nurse is teaching the client who is receiving chemotherapy and the family how to manage possible nausea and vomiting at home. What information should the nurse include in the teaching plan? A. Eating frequent, small meals. B. Include soft foods in the diet. C. Drink a milkshake made with fruit every day. D. Limit the amount of fluid intake.

A. Eating frequent, small meals. To reduce the adverse effects of chemotherapy such as nausea and vomiting, the nurse can suggest that the client eat small meals more frequently, which will be better tolerated while maintaining adequate nutrition. It is not necessary to eat soft food or milkshakes blended with fruit. Fluid intake should be encouraged to avoid dehydration.

A client asks the nurse what PSA is. The nurse should reply that it stands for A. prostate-specific antigen, which is used to screen for prostate cancer. B. protein serum antigen, which is used to determine protein levels. C. pneumococcal strep antigen, which is a bacteria that causes pneumonia. D. papanicolaou-specific antigen, which is used to screen for cervical cancer.

A. prostate-specific antigen, which is used to screen for prostate cancer. PSA stands for prostate-specific antigen, which is used to screen for prostate cancer.

An adult client with lymphoma reports cough, difficulty swallowing, and shortness of breath. On physical exam the client's face and neck are swollen and the upper extremities are cyanotic. What is the nurse's best course of action? A. Reassure the client that that this is to be expected with this type of cancer. B. Monitor the respiratory pattern of the client continually. C. Limit physical activities. D. Limit activities to bed rest.

B. Monitor the respiratory pattern of the client continually. The client has symptoms of superor vena cava syndrome. The symptoms are not expected side effects. The client should be monitored for respiratory distress. Activities may be limited, but the priority action of the nurse is early recognition of impending respiratory distress.

Which client has the highest risk of ovarian cancer? A. 30-year-old woman taking hormonal contraceptives B. 36-year-old woman who had her first child at age 22 C. 40-year-old woman with three children D. 45-year-old woman who has never been pregnant

D. 45-year-old woman who has never been pregnant The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.

A nurse is assessing a client with lymphoma who reports distress 9 days after chemotherapy. Because of the risk for septic shock, the nurse should assess the client for which cluster of symptoms? A. flushing, decreased oxygen saturation, mild hypotension B. low-grade fever, chills, tachycardia C. elevated temperature, oliguria, hypotension D. high-grade fever, normal blood pressure, increased respirations

B. low-grade fever, chills, tachycardia Nine days after chemotherapy, it is expected for the client to be immunocompromised. The clinical signs and symptoms of shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, tachycardia, and chills may be early signs of shock. The client with signs and symptoms of impending septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased.

The nurse is developing a care plan for a client who has had radiation therapy for Hodgkin's lymphoma. What is the primary goal of care for this client? A. Maintain fluid balance. B. Obtain sufficient exercise. C. Prevent infection. D. Avoid depression.

C. Prevent infection. The client with Hodgkin's lymphoma who has had radiation therapy is prone to infection; therefore, the primary goal is to prevent infection. The nurse instructs the client to perform frequent hand hygiene, avoid crowded areas, and report a temperature over 100°F (37.7°C). Maintaining fluid balance, exercising, and maintaining mental health are also important, but these are not primary goals at this time.

A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis? A. seizure disorder B. chronic obstructive pulmonary disease (COPD) C. anemia D. bleeding disorder

D. bleeding disorder A bleeding disorder is a contraindication for thoracentesis because a hemorrhage may occur during or after this procedure, possibly causing death. Although a history of a seizure disorder, COPD, or anemia calls for caution, it doesn't contraindicate thoracentesis.

The nurse is teaching the family of a client diagnosed with leukemia about ways to prevent infection. Which instruction has the most impact? A. bathing the client daily B. covering the client's mouth when coughing C. maintaining an intact skin integrity D. ingesting a plant-based diet

C. maintaining an intact skin integrity A client with leukemia has a compromised immune system. Maintaining skin integrity is a priority as the skin is a barrier to pathogens. If a pathogen enters the client's system, the client may not be able to fight off the bacteria and it will multiply and spread. Bathing daily can decrease bacteria on the skin but unless there is a break in the skin, the bacteria will remain on the skin. Covering the mouth when coughing protects others but does not have an impact on the client. Ingesting a plant-based diet may be nutritious, which helps the immune system; but, this does not have the most impact.

The nurse should teach clients about which potential risk factor for the development of colon cancer? A. chronic constipation B. long-term use of laxatives C. history of smoking D. history of inflammatory bowel disease

D. history of inflammatory bowel disease A history of inflammatory bowel disease is a risk factor for colon cancer. Other risk factors include age (older than 40 years), history of familial polyposis, colorectal polyps, and high-fat or low-fiber diet.

A client with suspected cervical cancer had a colposcopy with conization. What information should the nurse give the client about her menstrual periods after this surgery? A. Her periods will return to normal after 6 months. B. Her next two or three periods may be heavier and more prolonged than usual. C. Her next two or three periods will be lighter than normal. D. She may skip her next two periods.

B. Her next two or three periods may be heavier and more prolonged than usual. The client should be informed that her next two or three periods could be heavy and prolonged. The client is instructed to report any excessive bleeding. The nurse should reinforce the necessity for the follow-up check and the review of the biopsy results with the client. The client's periods will not be normal for 2 to 3 months.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? A. Urine output of 400 ml in 8 hours B. Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} C. Blood pressure of 120/64 to 130/72 mm Hg D. Sodium level of [142 mEq/L (142 mmol/L)]

B. Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

The nurse provides care to a client with anogenital warts. The nurse teaches that anogenital warts increase an adolescent female's risk of which condition? A. infertility B. cervical cancer C. dysmenorrhea D. urinary tract infections

B. cervical cancer Anogenital warts are associated with human papillomavirus (HPV) and increase an adolescent female's risk of cervical cancer. This risk mandates treatment of all external lesions. HPV doesn't increase the risk of infertility, infections, or painful menstrual cycles.

In assessing a client in the early stage of chronic lymphocytic leukemia (CLL), the nurse should determine if the client has: A. Enlarged, painless lymph nodes. B. Headache. C. Hyperplasia of the gums. D. Unintentional weight loss.

D. Unintentional weight loss. Clients with CLL develop unintentional weight loss; fever and drenching night sweats; enlarged, painful lymph nodes, spleen, and liver; decreased reaction to skin sensitivity tests (anergy); and susceptibility to viral infections. Enlarged, painless lymph nodes are a clinical manifestation of Hodgkin's lymphoma. A headache would not be one of the early signs and symptoms expected in CLL because CLL does not cross the blood-brain barrier and would not irritate the meninges. Hyperplasia of the gums is a clinical manifestation of AML.

Which client is at highest risk for colorectal cancer? A. the client who smoked 1 pack a day for 30 years B. the client who follows a vegetarian diet C. the client who has been treated for Crohn's disease for 20 years D. the client with a family history of lung cancer

C. the client who has been treated for Crohn's disease for 20 years Clients over age 50 who have a history of inflammatory bowel disease are at risk for colon cancer. The client who smokes is at high risk for lung cancer. While the exact cause is not always known, other risk factors for colon cancer are a diet high in animal fats, including a large amount of red meat and fatty foods with low fiber, and the presence of colon cancer in a first-generation relative.

A 52-year-old client is scheduled for a total abdominal hysterectomy for cervical cancer. When discussing the potential impact of this procedure on the client's sexuality, how should the nurse respond to the client? A. "All women experience sexual problems with this surgical procedure. Do you have any questions?" B. "When can I schedule an appointment with you and your partner to discuss any issues either of you may have regarding sexuality?" C. "Do you anticipate any problems with sex related to your scheduled hysterectomy?" D. "Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?"

D. "Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?" This question introduces some basic information and allows for support for the client who may be experiencing some sexuality concerns. Not all women experience sexual problems after undergoing a hysterectomy. Assuming that the client will want to schedule an appointment with her partner is inappropriate and may embarrass her. Simply asking the client whether she expects to have problems with sex is too abrupt and does not provide any information.

A nurse is conducting a cancer risk screening program. Which client is at greatest risk for skin cancer? A. 45-year-old health care worker B. 15-year-old high school student C. 30-year-old butcher D. 60-year-old mountain biker

D. 60-year-old mountain biker Basal cell carcinoma occurs most commonly in sun-exposed areas of the body. The incidence of skin cancer is highest in older people who live in the mountains or spend outdoor leisure time at higher altitudes.

A mastectomy is recommended for a 68-year-old client diagnosed with breast cancer a week ago. When approached about giving consent for the mastectomy, the client says, "What's the use in trying to get rid of the cancer? It will just come back! I can't handle another thing—having diabetes is enough. Besides, I'm getting old. It would be different if I were younger and had more energy." What should the nurse do? A. Accept the client's decision because it is her right to choose to obtain treatment or not. B. Give the client information about the survival rates for clients who underwent mastectomies. C. Call the chaplain to speak with the client about her hopeless attitude about the future. D. Explore with the client her feelings about her health problems and proposed surgery.

D. Explore with the client her feelings about her health problems and proposed surgery. While the client does have a right to accept or reject treatment, she has not explored her feelings, her possible mastectomy, or the future. The nurse should assist the client in exploring her feelings and moving toward a fuller understanding of her options. Giving the client survival rates indicates that the nurse feels she should have the surgery and negates her fears and concerns. While the chaplain might be helpful, this step should be done after the client has explored her feelings.

A client with ovarian cancer asks the nurse, "What is the cause of this cancer?" Which is the most accurate response by the nurse? A. Use of oral contraceptives increases the risk of ovarian cancer. B. Women who have had at least two live births are protected from ovarian cancer. C. There is less chance of developing ovarian cancer when one lives in an industrialized country. D. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors.

D. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. A definitive cause of carcinoma of the ovary is unknown, and the disease is multifactorial. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. The highest incidence is in industrialized Western countries. Endocrine risk factors for ovarian cancer include women who are nulliparous. Use of oral contraceptives does not increase the risk for developing ovarian cancer, but may actually be protective.

A nurse is interviewing a client about their past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? A. duodenal ulcers B. hemorrhoids C. weight gain D. polyps

D. polyps Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

Which statement indicates that a client understands the need for routine screening to detect colorectal cancer? A. "I need to have a colonoscopy at age 45 then every 10 years until age 75." B. "I will submit a stool sample for occult blood at age 50 and then yearly until age 75." C. "I will have a flexible sigmoidoscopy at age 45 and then every 10 years until age 70." D. "I need to have a stool DNA test at age 50 and repeat every 3 years."

A. "I need to have a colonoscopy at age 45 then every 10 years until age 75." The American Cancer Society (Canadian Cancer Society and Health Canada) recommends that starting at age 45, individuals of average risk undergo regular screening with one of six different tests and that screening happens through age 75. Colonoscopy should be repeated every 10 years. Fecal occult blood test (FOBT) should be repeated every year. Flexible sigmoidoscopy is recommended every 5 years. A stool DNA test is repeated every 3 years. The recommendations do not prioritize one test over another.

A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of possible lymphoma. Which statement made by the client demonstrates proper understanding of discharge teaching? Select all that apply. A. "I will take acetaminophen for pain." B. "I do not need to inspect the puncture site." C. "I will not be able to play basketball for the next 2 days." D. "I will take aspirin if I have pain." E. "I can apply an ice pack or a cold compress to the puncture site."

A. "I will take acetaminophen for pain." C. "I will not be able to play basketball for the next 2 days." E. "I can apply an ice pack or a cold compress to the puncture site." Acetaminophen is a safer analgesic than aspirin in order to avoid bleeding. Contact sports or trauma to the site should be avoided. Cool compresses should limit swelling and bruising. The puncture site should be inspected every 2 hours for bleeding or bruising during the first 24 hours.

An African-American/Black client is admitted for newly diagnosed leukemia under isolation precautions where only immediate family members may visit. A Caucasian visitor arrives to visit the client. What is the nurse's best response to the visitor? A. "There are some visiting limitations. Are you a family member?" B. "You cannot visit. You will have to check in with the family." C. "Only immediate family members are allowed to visit today." D. "No visitors are allowed while the client is on isolation precautions."

A. "There are some visiting limitations. Are you a family member?" The nurse should respond politely and respectfully, giving information while asking the visitor about family membership. Denying visitors in an argumentative manner, or presuming that the visitor is not a family member is disrespectful. Being on isolation precautions does not necessarily preclude visitors.

The nurse is reviewing assessment data of clients who may be at risk for developing malignant lymphoma. Which client would be at highest risk? A. A 22-year-old man with a history of mononucleosis B. A 25-year-old man who smokes a pack of cigarettes a day C. A 33-year-old man with a cousin with Hodgkin's lymphoma D. A 40-year-old woman with HIV

A. A 22-year-old man with a history of mononucleosis Malignant lymphoma has a peak incidence between ages 20 and 30, and after age 50. It's more common in men than women and is associated with a history of Epstein-Barr virus (which causes mononucleosis). There is also an increased incidence of the disease among siblings. There is no reported association between malignant lymphoma and smoking or HIV infection.

A client expresses to the nurse that they cannot get the mental support needed to prepare to undergo treatment for leukemia. Which nursing diagnosis is most appropriate for the client? A. Spiritual distress B. Ineffective coping C. Disturbed body image D. Anxiety

A. Spiritual distress The appropriate nursing diagnosis is Spiritual distress. The client expresses concern that they do not have inner or psychological strength, which indicates a need for spiritual support to regain faith and strength. The client does not exhibit any abnormal behavior; therefore, Ineffective coping is not the best diagnosis. Disturbed body image is also not suitable, because there is no mention of concern over appearance. Anxiety is always related to something unknown.

A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? A. Test all stools for occult blood. B. Administer topical ointment to the rectal area to decrease bleeding. C. Prepare the client for a gastrostomy tube placement. D. Administer morphine routinely, as ordered.

A. Test all stools for occult blood. Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed

The nurse examines the laboratory results for a client and notes a white blood cell (WBC) count of 112,000/mm3 (112 x109/L). What condition does the nurse review the client's medical record for to best explain this abnormal result? A. chronic myelogenous leukemia B. acute bacterial infection C. acute viral infection D. Hodgkin's disease

A. chronic myelogenous leukemia WBC count (leukocyte count) normally has an upper normal range of about 11,000/mm3 (11x109/L). While bacterial infections can increase the WBC moderately (up to 50,000/mm3 [50x109/L]), white counts above 100,000/mm3 (100x109/L) indicate a pathology such as leukemia is present. Some clients with chronic myelogenous leukemia can have WBC counts as high as 500,000/mm3 (500x109/L). This is due to the high number of granulocytes that are counted on the WBC test, even though these cells are not functioning as normal WBCs. Hodgkin's disease (Hodgkin's lymphoma) is a disease of the lymph nodes and can affect bone marrow, often resulting in decreased rather than increased WBCs. Acute viral infections can result in slightly lower than normal WBC counts due to viral effects on bone marrow activity.

Which nurse should be assigned to a client receiving brachytherapy for the treatment of cervical cancer? A. female nurse with 3 years' experience working in oncology B. male nurse who has floated to this unit from the operating room C. female nurse with 10 years' experience who suspects she may be pregnant D. male nurse who is also assigned to another client receiving brachytherapy

A. female nurse with 3 years' experience working in oncology Brachytherapy is internal radiation and nurses must use the principles of time, distance, and shielding. Radiation has cumulative effects and the nurse already working with a client receiving radiation should not be exposed to additional radiation. Working with clients who are receiving internal radiation takes a certain skill set, and the male nurse who has floated from the operating room is not the best person to work with this client. Radiation is harmful to the fetus, and the nurse who suspects she is pregnant should not be exposed to radiation

A client newly diagnosed with acute lymphocytic leukemia has a right subclavian central venous catheter in place. The nurse who is caring for the client is teaching a graduate nurse about central venous catheter care. The nurse should instruct the graduate nurse to change the dressing when? Select all that apply. A. per hospital policy B. every 72 hours C. when the dressing is becoming loose D. when the dressing is soiled E. when the site is reddened

A. per hospital policy C. when the dressing is becoming loose D. when the dressing is soiled E. when the site is reddened Research demonstrates that central lines are a large infection risk for clients. The dressing must be clean, dry, and intact to be effective. Sterile dressing change is indicated when the dressing does not meet this criteria; otherwise it is changed per hospital policy.

After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when the nurse notes tidal movements or fluctuations in which compartment of the system as the client breathes? A. water-seal chamber B. air-leak chamber C. collection chamber D. suction control chamber

A. water-seal chamber Fluctuations in the water-seal compartment are called tidal movements and indicate normal function of the system as the pressure in the tubing changes with the client's respirations. The air-leak meter — not chamber — detects air leaking from the pleural space. The collection chamber connects the chest tube from the client to the system. Drainage from the tube drains into and collects in a series of calibrated columns in this chamber. The suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest.

A client states, "I don't want any more tests. Who cares what kind of leukemia I have? I just want to be treated now." Which is the nurse's best response? A. "I"m sure you are frustrated and want to be well now." B. "Your treatment can be more effective if it is based on more specific information about your disease." C. "Now, you know the tests are necessary and that you are just upset right now." D. "I understand how you feel."

B. "Your treatment can be more effective if it is based on more specific information about your disease." The nurse is an advocate for the client with leukemia who can be empowered with knowledge of the treatment. Immunologic, cytogenic, morphologic, histochemical, and other means are used to identify cell subtypes and stages of leukemia cell development for very specific and optimal treatment. The nurse should not label the client's feeling, such as frustration or emotional; only the client can identify his or her own feelings. Chastising the client is not helpful. It disavows the client's emotional state and responses to the diagnosis and involved treatment. Unless nurses have had leukemia, they cannot possibly know how the client feels even though they may be trying to offer empathy.

When caring for a client with nonresectable colon cancer, which nursing diagnosis requires the nurse to function collaboratively to achieve the best outcome related to client comfort? A. Risk for deficient fluid volume B. Acute pain C. Activity intolerance D. Imbalanced nutrition: Less than body requirements

B. Acute pain A nurse must collaborate with a physician to achieve the best pain control for the client. A nurse may not give medications, such as analgesics and antibiotics, without a physician order, and the nurse assesses the client's response to pain medications and provides feedback to the physician. The nurse may assist the client with nonpharmacologic activities for pain control. The nurse may implement independent nursing interventions, such as performing assessments, providing appealing fluids, pacing nursing care to promote rest and minimize client fatigue, and providing small frequent meals to address Risk for imbalanced fluid volume, Activity intolerance, and Imbalanced nutrition.

A client diagnosed with acquired immunodeficiency disorder (AIDS) 10 years ago who is now receiving treatment for non-Hodgkin lymphoma asks the nurse, "Why am I getting both chemotherapy and radiation treatments?" What information is important for the nurse to know to answer this question? A. Since only 10% of clients with AIDS develop non-Hodgkin lymphoma, rapid treatment may produce better, even curative results. B. Non-Hodgkin lymphoma occurring in clients with AIDS is usually fast growing and both treatments may bring about an initial positive result. C. The best treatment for AIDS-related non-Hodgkin lymphoma now is the same treatment as those clients without AIDS. D. When non-Hodgkin lymphoma is detected early in the client with AIDS, only a series of chemotherapy treatments is typically used.

B. Non-Hodgkin lymphoma occurring in clients with AIDS is usually fast growing and both treatments may bring about an initial positive result. Non-Hodgkin lymphomas in AIDS clients is usually an aggressive disorder and treatment typically consists of both chemotherapy and radiation therapy. Rapid treatment may produce an initial positive response; however, the duration of this positive response is a short period of time. AIDS clients who develop non-Hodgkin lymphoma do not do as well as clients without AIDS due to an altered immune system. Treatment options include chemotherapy, chemotherapy with radiation, stem cell transplantation, or newer therapies in clinical trials.

The nurse is developing a discharge plan with a client who is receiving chemotherapy to treat lymphoma. What should the nurse include in the plan? Select all that apply. A. Wear a mask if leaving the house. B. Rest as needed. C. Avoid people with colds or flu. D. Decrease the protein in your diet. E. Contact the health care provider (HCP) if a fever develops.

B. Rest as needed. C. Avoid people with colds or flu. E. Contact the health care provider (HCP) if a fever develops. The nurse should teach the client to obtain as much rest as need, to avoid people who have a cold or the flu, and to report a fever to the HCP. It is not necessary for the client to wear a mask when going out of the house, but the client should avoid large crowds where there may be people with contagious diseases. It is not necessary to decrease the protein in the diet, but rather, the client should eat a well-balanced diet. The client may need to change some foods if the client has side effects of the chemotherapy and may need to obtain more calories.

The nurse teaches the client with chronic cancer pain about optimal pain control. Which recommendation is most effective for pain control? A. Get used to some pain, and use a little less medication than needed to keep from being addicted. B. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain. C. Take analgesics only when pain returns. D. Take enough analgesics around the clock so that you can sleep 12 to 16 hours a day to block the pain.

B. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain. The regular administration of analgesics provides a consistent serum level of medication, which can help prevent breakthrough pain. Therefore, taking the prescribed analgesics on a regular schedule is the best way to manage chronic cancer-related pain. There is little risk for the client with cancer-related pain to become addicted. Sleeping 12 to 16 hours a day would not allow the client to participate in usual daily activities or preferred activities.

The care of which client can be assigned to an unlicensed assistive personnel (UAP)? A. a client with stomatitis who requires instruction about mouth care before discharge B. a client who is having radiation for cancer of the stomach and is to have the radiation site bathed with warm water, followed by an application of a moisturizer C. a client who had a gastric resection and has a nasogastric tube draining bright red blood D. a client who had abdominal surgery and requires wet-to-dry dressing changes

B. a client who is having radiation for cancer of the stomach and is to have the radiation site bathed with warm water, followed by an application of a moisturizer The care of the client who is having radiation treatments and requires skin care at the site that involves bathing and application of a nonmedicated moisturizer is within the scope of practice for the UAP. Discharge planning, assessing drainage, and changing wet-to-dry dressings are nursing care activities that must be performed by a licensed nurse.

The nurse is speaking to a group of women about early detection of breast cancer. Which screening does the nurse recommend to women age 50 and older? A. annual self breast examination B. annual mammogram C. annual test for hormonal receptor assay D. biennial clinical breast examination by a healthcare provider

B. annual mammogram The Canadian Cancer Society states at 50 years that women should have a mammogram annually and a clinical examination at least annually (not every 2 years). The American Cancer Society recommends mammography yearly beginning at age 40. All women should perform breast self-examination monthly (not annually). The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen or progesterone dependent. An annual breast exam by a healthcare provider should be performed.

A client with human papillomavirus (HPV) infection is being treated by a colposcopy. The client asks the nurse if this procedure is really necessary. The nurse can tell the client that if the HPV infection is not treated which health problem is likely to occur? A. infertility B. cervical cancer C. pelvic inflammatory disease D. rectal cancer

B. cervical cancer HPV infection, or genital warts, can lead to dysplastic changes of the cervix, referred to as cervical intraepithelial neoplasia. The development of cervical cancer remains the largest threat of all condyloma-associated neoplasias. Infertility, pelvic inflammatory disease, and rectal cancer are not complications of genital warts.

A client with cervical cancer is undergoing internal radium implant therapy. A lead-lined container and a pair of long forceps have been placed in the client's hospital room. What should the nurse tell the client about how these will be used? The forceps and container will be used for: A. disposal of emesis or other bodily secretions. B. handling of the dislodged radiation source. C. disposal of the client's eating utensils. D. storage of the radiation dose.

B. handling of the dislodged radiation source. Dislodged radioactive materials should not be touched with bare or gloved hands. Forceps are used to place the material in the lead-lined container, which shields the radiation. Exposure to radiation can occur only by direct exposure to the encased radioactive substance; it cannot result from contact with emesis or urine or from touching the client. Disposal of eating utensils cannot lead to radiation exposure. Radioactive dose materials are kept only in the radiation department.

A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (Canadian Cancer Society) guidelines, the nurse should recommend that the women A. perform breast self-examination annually. B. have a mammogram annually. C. have a hormonal receptor assay annually. D. have a physician conduct a clinical examination every 2 years.

B. have a mammogram annually. The American Cancer Society (Canadian Cancer Society) guidelines state that women age 40 and older should have a mammogram annually and a clinical examination at least annually (not every 2 years). All women should perform breast self-examination monthly (not annually). The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.

The nurse is witnessing the client's signature on the informed surgical consent for an abdominal hysterectomy. The nurse should be certain the client understands that what will be the outcome of this surgery? A. decreased libido. B. infertility. C. depression. D. weight gain.

B. infertility. The client needs to understand that with removal of the uterus she will no longer be able to bear children or have menstrual periods. The surgical procedure should not change her libido or sexual functioning. Research does not support the idea that hysterectomy contributes to depression or weight gain. Research demonstrates that women who have managed health problems for some time before the hysterectomy may actually have a more positive effect, with less worry about their health condition, contraception, or pregnancy.

A nurse attending to the discharge of two clients learns that they will be caring for a client newly diagnosed with leukemia. The nurse has limited time to evaluate the new client. What should be the nurse's priority consideration as the nurse plans the time? A. evaluating the new client's teaching needs and coping mechanisms B. performing basic care tasks before evaluating the new client C. verifying the availability of adequate support staff D. reading the client's chart to see if the nurse has gathered all the necessary information

B. performing basic care tasks before evaluating the new client Although it's important to evaluate a new client's teaching needs and coping mechanisms, the nurse's first priority is to attend to the client's need for physical care. Verifying the availability of adequate support staff is important, but not the most pressing need in relation to the new client. A client with newly diagnosed leukemia has many levels of need. After the nurse has addressed the client's basic physiologic needs, the nurse should thoroughly evaluate the client's coping skills and psychosocial support system. The nurse may incorporate their evaluation into basic care and explore it in more detail at a later time.

Which signs and symptoms of leukemia would lead the nurse to suspect the client has thrombocytopenia? Select all that apply. A. fever B. petechiae C. epitaxis D. anorexia E. bone pain F shortness of breath

B. petechiae C. epitaxis Children with acute lymphocytic leukemia have a reduced platelet count (thrombocytopenia), reduced red blood cell count (anemia), and reduced white blood cell count (neutropenia) because of unrestricted proliferation of immature white blood cell. Chemotherapy is used to treat leukemia and contributes to thrombocytopenia, neutropenia, and anemia. Clients with thrombocytopenia are at risk for bleeding. Petechiae (small red or purple spots on the skin) and epistaxis (nose bleeds) are both signs of bleeding. A fever is a result of a decreased white blood cell count. Anorexia and dyspnea (shortness of breath) are a result of a decreased red blood cell count. Bone pain is a result of stress on the bone related to the unrestricted proliferation of the leukemic blast cells.

A client is receiving monthly doses of chemotherapy for treatment of stage III colon cancer. Which laboratory results should the nurse report to the oncologist before the next dose of chemotherapy is administered? Select all that apply. A. hemoglobin of 14.5 g/dL (145 g/L) B. platelet count of 40,000/mm3 (40 X 109/L) C. blood urea nitrogen (BUN) level of 12 mg/dL (4.3 mmol/L) D. white blood cell count of 2,300/mm3 (2.3 X 109/L) E. temperature of 101.2° F (38.4° C) F. urine specific gravity of 1.020

B. platelet count of 40,000/mm3 (40 X 109/L) D. white blood cell count of 2,300/mm3 (2.3 X 109/L) E. temperature of 101.2° F (38.4° C) Chemotherapy causes bone marrow suppression and risk of infection. A platelet count of 40,000/mm3 (40 X 109/L) and a white blood cell count of 2,300/mm3 (2.3 X 109/L) are low. A temperature of 101.2° F (38.4° C) is high and could indicate an infection. Further assessment and examination should be performed to rule out infection. The BUN, hemoglobin, and specific gravity values are normal.

Which action is most important when the nurse is planning pain management for a client after a lobectomy for lung cancer? A. repositioning the client immediately after administering pain medication B. reassessing the client after administering pain medication C. reassuring the client after administering pain medication D. readjusting the pain medication dosage as needed

B. reassessing the client after administering pain medication It is essential for the nurse to evaluate the effects of pain medication after it has had time to act. Although other interventions may be appropriate, continual reassessment is most important to determine the effectiveness and need for additional intervention, if any. Repositioning could provide some comfort, but assessment of the client's pain level is essential. Reassuring the client is important, but it will be of no value unless the nurse evaluates the client's pain level. To readjust the pain dosage is appropriate only if titration is prescribed by the health care provider (HCP).

A client with a modified radical mastectomy is being discharged. The client has been very reluctant to discuss the surgery or her situation. The nurse making assignments should delegate the client's care to the: A. unlicensed assistive personnel (UAP) because the client is stable and being discharged. B. same nurse who has cared for her the past 3 days, for continuity of care. C. nurse in orientation who needs experience in discharge instructions. D. nurse with the most bed baths, because this client will not need a bath.

B. same nurse who has cared for her the past 3 days, for continuity of care. Continuity of care is crucial for this client to feel more comfortable about asking questions and discussing her care at home. A UAP does not have the educational preparation (registered nursing license) to provide discharge instructions. It is not appropriate to assign this client to a nurse in orientation or one who needs assistance; the priority need is continuity of care.

A client with multiple myeloma presents to the emergency department complaining of excessive thirst and constipation. The client's family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? A. platelet count 300,000/mm3 (0.3 L) B. serum calcium level 13.8 mg/dl (0.766 mmol/L) C. serum sodium level of 133 mEq/L (133 mmol/L) D. hemoglobin of 9.8 g/dl (98 g/L)

B. serum calcium level 13.8 mg/dl (0.766 mmol/L) Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms.

On a visit to the gynecologist, a client complains of urinary frequency, pelvic discomfort, and weight loss. After a complete physical examination, blood studies, and a pelvic examination with a Papanicolaou test, the physician diagnoses stage IV ovarian cancer. The nurse expects to prepare the client for which initial treatment? A. radiation therapy B. surgical procedure C. chemotherapy D. none (At this advanced stage, ovarian cancer isn't treatable.)

B. surgical procedure Ovarian cancer usually requires aggressive treatment — initially, surgery. The client will require a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. Radiation therapy is palliative for a client in this advanced stage of the disease. Chemotherapy also is largely palliative during this stage; however, prolonged remissions have been achieved in some clients.

A client with chronic cancer pain has been receiving opiates for 4 months. She rated the pain as an 8 on a 10-point scale before starting the opioid medication. Following a thorough examination, there is no new evidence of increased disease, yet the pain is close to 8 again. What is the most likely explanation for the increasing pain? A. development of an addiction to the opioids B. tolerance to the opioid C. withdrawal from the opioid D. placebo effect has decreased

B. tolerance to the opioid Tolerance to an opioid occurs when a larger dose of the analgesic is needed to provide the same level of pain control. The risk of addiction is low with opioids to treat cancer pain. There are no data to support that this client is experiencing withdrawal. Although the client may have experienced a placebo effect at one time, placebo effects tend to diminish over time, especially in regard to chronic cancer pain.

The nurse is assigned a client with end-stage ovarian cancer with recurrent ascites, and the client is to undergo paracentesis. Which activity is best to delegate to an experienced licensed practical nurse (LPN/VN)? A. completing the client admission B. vital signs every 15 minutes after the paracentesis C. providing discharge instructions after the paracentesis D. obtaining a paracentesis tray from central supply

B. vital signs every 15 minutes after the paracentesis To delegate nursing care effectively, a nurse must know the client's condition, the competence and scope of practice of all nursing team members, and the level of supervision needed for the delegated nursing care task. The nurse must also consider the training, cultural competence, and experience of the delegate. Delegating nursing care requires critical thinking and professional judgment to ensure that the delegated nursing care task is the right task for the right person, the task is delegated under the right circumstances, the delegate receives the right directions and communication, and the performance of the task is properly supervised and evaluated. An experienced LPN/LVN would monitor and report vital signs to the RN. The paracentesis tray can be obtained by the unit clerk or unlicensed assistive personnel (UAP). The admission assessment and teaching require the RN's expertise and education.

A client tells the nurse that her bra fits more snugly at certain times of the month and she is concerned this may be a sign of breast cancer. The nurse should give the client which information about this situation? A. A change in breast size should be checked by her health care provider (HCP). B. Benign cysts tend to cause the breast to vary in size. C. It is normal for the breast to increase in size before menstruation begins. D. A difference in the size of her breasts is related to normal growth and development.

C. It is normal for the breast to increase in size before menstruation begins. Normally, breasts are about the same size. They can vary in size before menstruation due to breast engorgement caused by hormonal changes. It is not necessary for a HCP to check this slight change in breast size. The changes in breast size this client described are most likely caused by hormonal changes, not a benign cyst or normal growth and development.

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last two cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? A. Perform a cardiovascular assessment every 4 hours. B. Ask the client to report any shortness of breath. C. Monitor daily platelet counts. D. Ask the client to report any bleeding or bruising.

C. Monitor daily platelet counts. The nurse should monitor daily laboratory results as this is objective data that will alert the nurse to decreasing platelet counts. Relying on the client to report bleeding or bruising may result in the late discovery of the decreased platelet count. Performing a cardiovascular assessment every 4 hours and asking the client to report shortness of breath will not help detect early signs and symptoms of thrombocytopenia.

The nurse on the previous night shift documented that the lungs of a client with lung cancer were CTA (clear to auscultation) in all fields. While doing the shift assessment, the day shift nurse noticed decreased breath sounds, especially in the right lower lobe. Which action is the nurse's best choice? A. Report the findings to the charge nurse for documentation follow up with the previous shift's nurse. B. Document the findings as the only action, as this is expected in clients with lung cancer. C. Notify the physician of the change in client status. D. Call radiology for an X-ray to confirm findings.

C. Notify the physician of the change in client status. Pleural effusion is a common complication of lung cancer. Fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished. Documentation of abnormal findings without any follow up is an error in the nursing process. Ordering an X-ray is not an independent nursing action.

The nurse is reviewing the lab report for a client in hospice care with breast cancer and brain metastasis. According to the information in the chart, what should the nurse do next? A. Document these results on the medical record. B. Report the elevated potassium level immediately. C. Report the elevated calcium level immediately. D. Refrain from reporting the results because the client is in hospice care.

C. Report the elevated calcium level immediately. The normal calcium level is 9.0 to 10.5 mg/dL (2.25 to 2.63 mmol/L). Hypercalcemia is commonly seen with malignant disease and metastases. The other laboratory values are normal. Hypercalcemia can be treated with fluids, furosemide, or administration of calcitonin. Failure to treat hypercalcemia can cause muscle weakness, changes in level of consciousness, nausea, vomiting, abdominal pain, and dehydration. Although the client is on hospice care, she will still need palliative treatment. Comfort and risk reduction are components of hospice care.

A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which assessment made after the procedure would indicate the development of a potential complication? A. The client has a sore throat. B. The client displays signs of sedation. C. The client experiences a sudden increase in temperature. D. The client demonstrates a lack of appetite.

C. The client experiences a sudden increase in temperature. The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike within 1 to 2 hours after the procedure is indicative of a perforation and should be reported immediately to the health care provider. A sore throat is to be anticipated after an endoscopy. Clients are given sedatives during the procedure, so it is expected that they will display signs of sedation after the procedure is completed. A lack of appetite could be the result of many factors, including the disease process.

A nurse is assessing a client with a family history of cancer. Which finding requires immediate follow-up? A. The client has gained 10 lb (4.5 kg) over the past year. B. The client reports knee pain upon rising. C. The client reports a feeling of a lump in the throat. D. The client has a blood pressure of 135/80 mmHg and a pulse rate of 70 beats/minute.

C. The client reports a feeling of a lump in the throat. The sensation of a lump in the throat is one of the warning signs of esophageal cancer and requires immediate follow-up. Other symptoms of esophageal cancer include dysphagia, substernal pain, regurgitation of undigested food, foul breath, and hiccups. A weight gain of 10 lb in a year, a blood pressure of 135/80 mmHg, and a pulse rate of 70 beats/minute are normal findings. Although the nurse should ultimately investigate the complaint of pain in the knees upon rising, this finding isn't the priority at this time.

A nurse is teaching an older adult who has had a left modified radical mastectomy with axillary node dissection about lymphedema. What should the nurse tell the client about when lymphedema occurs? A. if all cancer cells are not removed B. in older women C. at any time after surgery D. only with radical mastectomy

C. at any time after surgery Lymphedema after breast cancer surgery is the accumulation of lymph tissue in the tissues of the upper extremity extending down from the upper arm. It may occur at any time after surgery in women of any age. It is caused by the interruption or removal of lymph channels and nodes after axillary node dissection. Removal results in less efficient filtration of lymph fluid and a pooling of lymph fluid in the tissues on the affected side. Treatments or interventions should be instituted as soon as lymphedema is noted to prevent or reduce further progression. Range-of-motion exercises, elevation, and avoidance of injury in the affected arm are important when completing client teaching. The health care provider (HCP) may also prescribe a compression sleeve. Lymphoma is not caused by failure to remove all cancer cells. Lymphedema can occur after any surgery that disrupts lymph flow, not just radical mastectomy.

A client has malignant lymphoma. As part of thier chemotherapy, the physician orders an alkylating drug. When caring for the client, the nurse teaches the client about adverse reactions to alkylating drugs. The nurse tells the client that they might begin to see adverse reactions A. immediately. B. in 1 week. C. in 2 to 3 weeks. D. in 1 month.

C. in 2 to 3 weeks. The nurse should tell the client that they might see adverse reactions, such as alopecia, 2 to 3 weeks after starting therapy with an alkylating drug.

A nurse is caring for a client who had a prostatectomy for prostate cancer. The nurse is reviewing the client's vital signs and intake and output as documented by a nursing assistant. (BP: 110/64, HR: 78, RR: 14, T: 99.4, Intake: 1420mL, Output: 330mL) Which documented finding requires immediate action? A. blood pressure B. heart rate C. intake and output D. temperature

C. intake and output The client has a significantly greater intake than output. This finding may indicate that the catheter is blocked and causing urine retention. The nurse should immediately irrigate the catheter and try to determine if clots are blocking the catheter. If the nurse is unable to irrigate the catheter, the healthcare provider should be notified immediately. The client's heart rate and blood pressure are normal. Although the temperature is slightly elevated, this finding is not a priority at this time.

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for A. chronic liver failure. B. acute heart failure. C. pathologic bone fractures. D. hypoxemia.

C. pathologic bone fractures. Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

A nurse is completing an admission interview of a client newly diagnosed with multiple myeloma. The client expresses concerns about insurance coverage and financial needs. Based on this information, to whom would the nurse initiate a referral? A. hospice B. financial advisor C. social services D. case management

C. social services A social worker can be extremely beneficial in helping clients identify additional personal and community funding resources and support groups. A hospice referral is not appropriate for a client with a new diagnosis who is seeking treatment. The nurse would not refer the client to a financial advisor as these advisors typically focus on wealth management, not the identification of resources. A referral to case management would be contingent on the client's insurance requirements and would not address the immediate concern.

A client who is receiving chemotherapy expresses concern at the thought of losing hair on the head. The nurse's best response is: A. "Don't worry about your hair loss. A good wig can disguise that." B. "No one knows how long it will take your hair to grow back. You'll have to learn to cope with its loss." C. "A little hair loss shouldn't concern you. You have more serious things to worry about." D. "Your hair loss will be temporary. Would you like to tell me about your concerns?"

D. "Your hair loss will be temporary. Would you like to tell me about your concerns?" Alopecia, which can occur with the administration of some chemotherapeutic agents, is psychologically disturbing for many clients even though the loss is temporary. Clients should be reassured that their hair will grow back. The nurse should encourage the client to discuss any concerns and should explore the various options available to the client (e.g., caps, wigs, scarves, turbans). Telling the client not to worry about hair loss or that there are more serious worries trivializes the client's concerns. Telling the client to learn to cope with hair loss conveys negativity and harsh judgment and is likely to demoralize the client.

A nurse is caring for a client who is receiving chemotherapy for lung cancer. During the hand-off report, the nurse from the previous shift states that the client has been placed on neutropenic precautions. Which laboratory value supports this nursing action? A. a red blood cell count of 3.5 million/mm3 B. a platelet count of 90,000 per microliter C. a retculocyte count of 1% D. a white blood cell count of 2200/mm3

D. a white blood cell count of 2200/mm3 The normal number of WBCs in the blood is 4,500-10,000 white blood cells per microliter (mcL). Less than 4,500 is considered neutropenia and places the client at risk for infection. The platelet count ranges from 150,000 to 450,000/mcL. Platelets are responsible for blood clotting. The nurse needs to institute bleeding precautions for this, not neutropenic precautions. Red blood cells are responsible for oxygen transport. The reticulocyte count is normal.

During the induction stage for treatment of leukemia, the nurse should remove which items that the family has brought into the room? A. a prayer book B. a picture C. a bouquet of flowers D. a hairbrush

C. a bouquet of flowers The induction phase of chemotherapy is an aggressive treatment to kill leukemia cells. The client is severely immunocompromised and severely at risk for infection. Flowers, herbs, and plants should be avoided during this time. The client's prayer book, pictures, and other personal belongings can be cleaned before being brought into the room to prevent client contact with pathogenic and nonpathogenic organisms.

A client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the right arm, and the client's left arm and hand should be elevated as much as possible to prevent: A. carpal tunnel syndrome. B. peripheral neuropathy. C. contractures. D. lymphedema.

D. lymphedema. Lymphedema is a common postoperative effect of modified radical mastectomy and lymph node dissection. Elevation of the left arm and hand will allow gravity to assist lymph drainage. Other preventive measures include exercises in which the arms are elevated. Peripheral neuropathy is not associated with postoperative complications, nor are contractures. Although muscle atrophy is a potential adverse effect if the client does not exercise the left arm, it would not be prevented by elevation.

An adult with a history of chronic obstructive pulmonary disease (COPD) and metastatic carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice program. The nurse should conduct a focused assessment for which symptom? A. ascites B. pleural friction rub C. dyspnea D. peripheral edema

C. dyspnea Dyspnea is a distressing symptom in clients with advanced cancer including metastatic carcinoma of the lung, previous radiation therapy, and coexisting COPD. Ascites does occur in clients with metastatic carcinoma; however, in the client with COPD and lung cancer, dyspnea is a more common finding. A pleural friction rub is usually associated with pneumonia, pleurisy, or pulmonary infarct.

Which nursing goal is appropriate for the nurse to make with a client who has multiple myeloma? A. Achieve effective management of bone pain. B. Recover from the disease with minimal disabilities. C. Decrease episodes of nausea and vomiting. D. Avoid hyperkalemia.

A. Achieve effective management of bone pain. In multiple myeloma, neoplastic plasma cells invade the bone marrow and begin to destroy the bone. As a result of this skeletal destruction, pain can be significant. There is no cure for multiple myeloma. Nausea and vomiting are not characteristics of the disease, although the client may experience anorexia. The client should be monitored for signs of hypercalcemia resulting from bone destruction, not for hyperkalemia.

The nurse is planning a presentation about ovarian cancer to a group of women. Which topic should receive priority attention in the lesson plan? A. Ovarian cancer signs and symptoms are often vague until late in development. B. Ovarian cancer should be considered in any woman older than 30 years of age. C. A rigid board-like abdomen is the most common sign. D. Methods for early detection have made a dramatic reduction in the mortality rate due to ovarian cancer.

A. Ovarian cancer signs and symptoms are often vague until late in development. Ovarian cancer is rarely diagnosed early. Methods for mass screening and early detection have not been successful. Signs and symptoms are often vague until late in development. Ovarian cancer should be considered in any woman older than 40 years of age who has vague abdominal and/or pelvic discomfort or enlargement, a sense of bloating, or flatulence. Enlargement of the abdomen due to the accumulation of fluid is the most common sign.

A client recruited to participate in a clinical trial to treat non-Hodgkin's lymphoma voices concerns about the adverse effects of the treatment preventing the completion of the trial. What will the nurse tell the client to protect the principle of autonomy? A. "Adverse effects will be managed with medication." B. "Participation in the trial may benefit others." C. "You may withdraw at any time." D. "There are risks and benefits associated with trial participation."

C. "You may withdraw at any time." Although the nurse must tell the client how adverse effects will be treated and the risks and benefits associated with participating in the trial, the most crucial element in protecting the ethical principle of autonomy is to inform the client that they may withdraw at any time without punitive consequences. Telling the client how participation in the trial will benefit others takes the focus from the client and does not support autonomy.

The nurse is conducting a health history for a client at risk for cancer. Which lifestyle factor is considered a risk for colorectal cancer? A. a diet low in vitamin C B. a high dietary intake of artificial sweeteners C. a high-fat, low-fiber diet D. multiple sex partners

C. a high-fat, low-fiber diet A high-fat, low-fiber diet is a risk factor for colorectal cancer. A diet low in vitamin C, use of artificial sweeteners, and multiple sex partners are not considered risk factors for colorectal cancer.

After a mastectomy for breast cancer, the nurse teaches the client how to avoid the development of lymphedema. The nurse should teach the client to: A. apply an elastic bandage to the affected extremity. B. limit range-of-motion exercises in the shoulder and elbow. C. elevate the affected arm on a pillow. D. use diuretics as necessary to decrease swelling.

C. elevate the affected arm on a pillow. The client should be taught to elevate the affected arm on a pillow to promote venous return and lymphatic drainage of the area. Applying an elastic bandage is inappropriate because constriction of the extremity should be avoided. Range-of-motion exercising is not limited. Rather, it is encouraged. Diuretics are not used to control lymphedema.

Which nursing intervention is most appropriate for a client with multiple myeloma? A. monitoring respiratory status B. balancing rest and activity C. restricting fluid intake D. preventing bone injury

D. preventing bone injury When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict their fluid intake.

A client with stage II ovarian cancer undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. During the second postoperative day, which assessment finding requires immediate intervention? A. abdominal pain B. hypoactive bowel sounds C. serous drainage from the incision D. shallow breathing and increasing lethargy

D. shallow breathing and increasing lethargy Shallow breathing and a change in the level of consciousness, such as increasing lethargy requires immediate intervention because they may indicate a respiratory complication — for example, atelectasis or carbon dioxide retention. To avoid respiratory complications, the nurse should encourage turning, coughing, deep breathing, and ambulation during the early postoperative period. Abdominal pain, hypoactive bowel sounds, and serous drainage from the incision are expected findings during the first few days after this type of surgery.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? A. hypercalcemia B. hyperkalemia C. hypernatremia D. hypermagnesemia

A. hypercalcemia Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.

The nurse understands that the client who is undergoing induction therapy for leukemia needs additional instruction when the client makes which statement? A. "I will have to pace my activities with rest periods." B. "I cannot wait to get home to my cat!" C. "I will use warm saline gargle instead of brushing my teeth." D. "I must report a temperature of 100° F (37.7 C)."

B. "I cannot wait to get home to my cat!" The nurse identifies that the client does not understand that contact with animals must be avoided because they carry infection and the induction therapy will destroy the client's white blood cells (WBCs). The induction therapy will cause anemia, and the client will experience fatigue and will have to pace activities with rest periods. Platelet production will be decreased, and the client will be at risk for bleeding tendencies; oral hygiene will have to be provided by using a warm saline gargle instead of brushing the teeth and gums. The client will be at risk for infection owing to the decrease in WBC production and should report a temperature of 100° F (37.8° C) or higher

A client with brown hair is concerned about losing hair as a result of chemotherapy. What should the nurse tell the client? A. "The new growth of hair will be gray." B. "The hair loss is temporary." C. "New hair growth will always be the same texture and color as it was before chemotherapy." D. "Avoid use of wigs when possible."

B. "The hair loss is temporary." Alopecia from chemotherapy is temporary. The new hair will not be necessarily gray, but the texture and color of new hair growth may be different. Clients who will be receiving chemotherapy should be encouraged to purchase a wig while they still have hair so that they can match the color and texture of their hair. Loss of hair, or alopecia, is a serious threat to self-esteem and should be addressed quickly before treatment.

A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include A. serum creatinine level 0.5 mg/dl (44.2 mcmol/L) B. serum calcium level of 7.5 mg/dl (1.9 mmol/L) C. Bence Jones protein in the urine D. serum protein level 5.8 g/dl (58 g/L)

C. Bence Jones protein in the urine Presence of Bence Jones protein in the urine almost always confirms multiple myeloma; however, absence of the protein doesn't rule out the disease. Serum creatinine level may be increased (above 1.2 mg/dl in men and 0.9 mg/dl in women). Serum calcium levels are above 10.2 mg/dl (2.55 mmol/L) in multiple myeloma because calcium is lost from the bone and reabsorbed in the serum. The serum protein level is increased in multiple myeloma, not decreased.

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous? A. eversion of the right nipple and mobile mass B. nonmobile mass with irregular edges C. mobile mass that is soft and easily delineated D. nonpalpable right axillary lymph nodes

B. nonmobile mass with irregular edges Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction — not eversion — may be a sign of cancer.

A client had a right pneumonectomy for lung cancer yesterday and now has dyspnea. What position in bed will be best for this client? A. lying on the left side B. positioned for postural drainage C. head of bed elevated D. flat in bed on full bed rest

C. head of bed elevated The client will be most comfortable and have the best lung expansion with the head of the bed elevated. When in a side lying position, the client should lie on the right side to permit expansion of the unaffected lung. Postural drainage positioning will lower the head of bed and increase dyspnea. Lying flat will increase the dyspnea; the client should be encouraged to be out of bed as tolerated.

The nurse is examining charts to identify clients at risk for developing multiple myeloma. Which client is most at risk? A. a 20-year-old Asian woman B. a 30-year-old White man C. a 50-year-old Hispanic woman D. a 60-year-old Black man

D. a 60-year-old Black man Multiple myeloma is more common in middle-aged and older adult clients. The median age at diagnosis is 60 years. It is twice as common in Black clients as it is in White clients, and it occurs most often in Black men.

Which strategy will be most effective in improving transcultural communications with oncology clients and their families? A. Use touch to show concern and caring for the client. B. Focus attention on verbal communication skills only. C. Establish a rapport and listen to their concerns. D. Maintain eye contact at all times.

C. Establish a rapport and listen to their concerns. It is important to establish rapport with the client and family by listening to verbal and nonverbal concern and showing respect for cultural differences. The use of touch or eye contact is culture-specific and cannot be generalized as an intervention for all individuals with cancer. Miscommunication between individuals of different cultures is often caused by language differences, rules of communication, age, and gender.

Which outcome is expected of a nursing referral to a cancer support group? The client can: A. choose the best treatment options. B. find financial help. C. obtain home health care. D. cope with cancer.

D. cope with cancer. Support groups are designed to educate clients and their families experiencing cancer about the disease and methods of coping positively with it. These are self-help and support groups monitored by professionals and cancer survivors who have undergone a training course that helps them to facilitate small groups.

Which expected outcome about nutrition would be appropriate for a client who has had a total gastrectomy for gastric cancer? The client will: A. regain any weight lost within 4 weeks of the surgical procedure. B. eat three full meals a day without experiencing gastric complications. C. learn to self-administer enteral feedings every 4 hours. D. maintain adequate nutrition through oral or parenteral feedings.

D. maintain adequate nutrition through oral or parenteral feedings. An appropriate expected outcome is for the client to maintain nutrition either through oral or total parenteral feedings. Oral and total parenteral nutrition may also be used concurrently. It is not realistic to expect the client to regain weight loss within 4 weeks of surgery. After surgery, it is recommended that the client eat six small meals a day rather than three full meals to decrease symptoms of dumping syndrome. Enteral feedings are not part of the expected outcome for gastric surgery.

After instructing a 20-year-old nulligravid (never been pregnant) client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect? A. weight gain B. nausea C. headache D. ovarian cancer

D. ovarian cancer The nurse determines that the client needs further instruction when the client says that one of the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. Other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious adverse effect is thrombophlebitis.

The client is a survivor of non-Hodgkin's lymphoma. Which statement indicates the client needs additional information? A. "Regular screening is very important for me." B. "The survivor rate is directly proportional to the incidence of second malignancy." C. "The survivor rate is indirectly proportional to the incidence of second malignancy." D. "It is important for survivors to know the stage of the disease and their current treatment plan."

B. "The survivor rate is directly proportional to the incidence of second malignancy." It is incorrect that the survivor rate is directly proportional to the incidence of second malignancy. The survivor rate is indirectly proportional to the incidence of second malignancy, and regular screening is very important to detect a second malignancy, especially acute myeloid leukemia or myelodysplastic syndrome. Survivors should know the stage of the disease and their current treatment plan so that they can remain active participants in their health care.

What is a risk factor for women who have human papillomavirus (HPV)? A. sterility B. cervical cancer C. uterine fibroid tumors D. irregular menses

B. cervical cancer Women who have HPV are much more likely to develop cervical cancer than women who have never had the disease. Cervical cancer is now considered a sexually transmitted disease. Regular examinations, including Papanicolaou tests, are recommended to detect and treat cervical cancer at an early stage. Girls and women as well as boys and men (around ages 9 to 26 depending on the vaccine) should receive a vaccine to prevent HPV. HPV does not cause sterility, uterine fibroid tumors, or irregular menses.

Which statement indicates that a new graduate nurse understands central venous pressure (CVP) measurement when used on a client? A. "The test accurately measures rate and rhythm of breathing patterns." B. "The test determines approximate blood pressure." C. "A high CVP leads to superior vena cava syndrome." D. "The test will assess pressure and volume changes in the right atrium."

D. "The test will assess pressure and volume changes in the right atrium." The best rationale for CVP measurement is to assess pressure and volume in the right atrium. CVP does not measure breathing patterns or blood pressure. Superior vena cava syndrome is usually caused by an obstruction such as a tumor or lymphoma.

A client with colon cancer is having a barium enema. The nurse should instruct the client to take which type of medication after the procedure is completed? A. laxative B. anticholinergic C. antacid D. demulcent

A. laxative After a barium enema, a laxative is ordinarily prescribed. This is done to promote elimination of the barium. Retained barium predisposes the client to constipation and fecal impaction. Anticholinergic drugs decrease gastrointestinal motility. Antacids decrease gastric acid secretion. Demulcents soothe mucous membranes of the gastrointestinal tract and are used to treat diarrhea.

A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member? A. social worker B. staff nurse C. clinical educator D. enterostomal nurse

D. enterostomal nurse The surgeon should collaborate with the enterostomal nurse, who can address the client's concerns. The enterostomal nurse may schedule a visit with a client who has a colostomy to offer support to the client. The clinical educator can provide information about the colostomy when the client is ready to learn. The staff nurse and social worker aren't specialized in colostomy care, so they aren't the best choices for this situation.

The family of an older adult with terminal cancer asks about having hospice services. What should the nurse tell the family? Hospice care: A. focuses only on the needs of the client. B. can only be provided in the inpatient setting. C. is staffed exclusively by professional health care workers. D. focuses on supportive care for the client and family.

D. focuses on supportive care for the client and family. Hospice care focuses on supportive care for the client and family. Care for the family may continue throughout the bereavement period. Hospice care involves care of the client at home as well as in an inpatient setting. Although professional care is provided in hospice, family members, volunteers, and unlicensed nursing personnel (UAP) also participate in the care of the client.

A client, age 42, visits the gynecologist. After examining the client, the healthcare provider suspects cervical cancer. What will be most important for the nurse to include in assessing the client's health history? A. the onset of sexual activity B. smoking history C. diet and exercise D. history of human papillomavirus infection

D. history of human papillomavirus infection The nurse would assess for risk factors associated with cervical cancer. The most important risk factor for cervical cancer is human papillomavirus infection. The onset of sexual activity may indirectly increase the risk of cervical cancer. Smoking is a risk factor for cervical cancer but not the most important one. Diet and exercise are not important risk factors for cervical cancer.

A client is being discharged after abdominal surgery and colostomy formation to treat colon cancer. Which nursing action is most likely to promote continuity of care? A. notifying the American Cancer Society (Canadian Cancer Society) of the client's diagnosis B. advocating for the client by ordering Meals on Wheels 5 days a week C. asking the physician to write an order for home skilled nursing assessments and interventions D. asking an occupational therapist to evaluate the client at home

C. asking the physician to write an order for home skilled nursing assessments and interventions Many clients are discharged from acute care settings so quickly that they don't receive complete instructions. Therefore, the first priority is to arrange for home healthcare. The American Cancer Society (Canadian Cancer Society) often sponsors support groups, which are helpful when the person is ready. However, contacting this organization would break client confidentiality, and even with the client's consent does not take precedence over ensuring proper home healthcare. Advocating for Meals On Wheels and asking for an occupational therapy evaluation are important, but these actions can occur later in rehabilitation.

A 30-year-old client whose mother died of breast cancer at age 44 and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic? A. mammogram B. papanicolaou (Pap) testing every 6 months C. contacting the American Cancer Society (Canadian Cancer Society) D. genetic counseling

D. genetic counseling The nurse should suggest that the client ask the physician about genetic counseling. Genetic counseling is indicated for those at high risk because of family or personal cancer history. Genetic counseling involves obtaining a detailed medical and three-generational family history; calculating a personalized risk assessment; providing options for prevention, surveillance, and genetic testing; coordinating and interpreting genetic testing; and developing a management plan based on the test results. Mammography will assist with early detection of most breast cancers, but it won't establish a risk assessment and provide options for prevention, surveillance, and genetic testing. Pap testing every 6 months assists in early detection of most cervical cancers, but it won't establish a risk assessment. Contacting the American Cancer Society (Canadian Cancer Society) won't help assess the client's risk for developing cancer.

A woman tells the nurse, "There has been a lot of cancer in my family." The nurse should instruct the client to report which possible sign of cervical cancer? A. pain B. leg edema C. urinary and rectal symptoms D. light bleeding or watery vaginal discharge

D. light bleeding or watery vaginal discharge In its early stages, cancer of the cervix is usually asymptomatic, which underscores the importance of regular Pap smears. A light bleeding or serosanguineous discharge may be apparent as the first noticeable symptom. Pain, leg edema, urinary and rectal symptoms, and weight loss are late signs of cervical cancer.

A client is receiving chemotherapy for treatment of acute lymphocytic leukemia. During discharge preparation, which topic is most important for the nurse to discuss with the client and caregivers? A. how to help the client adjust to an altered body image B. how to increase the client's interactions with peers C. the need to decrease the client's activity level D. ways to prevent infection

D. ways to prevent infection Because overwhelming infection is the most common cause of death in clients with leukemia, preventing infection is the most important teaching topic. Although promoting adjustment to an altered body image and increasing peer interactions are important, they don't address life-threatening concerns and therefore take lower priority. The nurse should advise the caregivers to let the client's desire and tolerance for activity determine the client's activity level.

The client with leukemia presents to the IV therapy clinic for chemotherapy. The nurse asks the client to roll up a sleeve to look for an IV access site. Which vein can the nurse access for this therapy? Select all that apply. A. antecubital B. cephalic C. dorsalis pedis D. antebrachial E. basilic

B. cephalic D. antebrachial E. basilic The preferred sites are the basilic, antebrachial, and cephalic areas. The dorsalis pedis is a pulse site, and the antecubital is at the bend of the arm, making this site unfavorable for a caustic medication.

A client with lymphoma tells the nurse that a holistic practitioner has offered to treat the client with coffee enemas. How does the nurse respond? A. "Unproven alternative therapy can be very dangerous." B. "You should speak with your oncologist about this treatment." C. "Have you researched this practitioner's qualifications?" D. "This treatment is questionable. It could be dangerous."

B. "You should speak with your oncologist about this treatment." In this situation, the nurse should try to maintain open communication and a strong therapeutic connection with the client. Although the treatment may be unproven, questionable, dangerous, or from an unqualified practitioner, telling the client so may make the nurse appear to be harsh and judgmental, thereby shutting down the dialogue. By referring the client to the oncologist, the nurse keeps lines of communication open and gives the client an opportunity to discuss treatment options in a difficult life situation.

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan? A. avoiding using deodorant soap on the irradiated areas B. applying talcum powder to the irradiated areas daily after bathing C. wearing a lead apron during direct contact with the client D. removing thoracic skin markings after each radiation treatment

A. avoiding using deodorant soap on the irradiated areas Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water and a mild soap only and leave the area open to air. No deodorants or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.

After a lobectomy for lung cancer, the nurse instructs the client to perform deep breathing exercises. What is the expected outcome of these exercises? A. Decrease blood flow to the lungs for rest and increased surface alveoli ventilation. B. Elevate the diaphragm to enlarge the thorax so that the lung surface area available for gas exchange is increased. C. Control the rate of air flow to the remaining lobe to decrease the risk of hyperinflation. D. Expand the alveoli and increase lung surface available for ventilation.

D. Expand the alveoli and increase lung surface available for ventilation. Deep breathing helps prevent microatelectasis and pneumonitis and also helps force air and fluid out of the pleural space into the chest tubes. It does not decrease blood flow to the lungs or control the rate of air flow. The diaphragm is the major muscle of respiration; deep breathing causes it to descend, thereby increasing the ventilating surface.