NURSING CARE (3)
The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed? a. I should take my temperature daily and when I don't feel well. b. I will wash my toothbrush in the dishwasher once a week. c. I wont let anyone share any of my personal items or dishes. d. Its alright for me to keep my pets and change the litter box.
ANS: D Clients should wash their hands after touching their pets and should not empty or scoop the cat litter box. The other statements are appropriate for self-management
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 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 anti-inflammatory 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
A client with a diagnosis of tonsillar cancer is receiving filgrastim (Neupogen®). Prior to administering the next dose of the medication the nurse notes that the client's absolute neutrophil count is 11,000/mm3. What is the nurse's best action? 1. Administer the medication as ordered. 2. Place the client on neutropenic precautions. 3. Notify the health-care provider because treatment will likely be discontinued. 4. Apply gown, gloves, and a mask when entering the room to administer the medication.
ANSWER: 3 Filgrastim is a granulocyte colony-stimulating factor for treatment of neutropenia. Treatment is usually discontinued when the absolute neutrophil count reaches 10,000/mm3. Unnecessary doses can cause leukocytosis (white blood cells above 100,000/mm3), an adverse effect of the medication. A normal neutrophil count is greater than 2,000/mm3. Neutropenic precautions and protective wear are unnecessary because the filgrastim (Neupogen®) has been effective in increasing the neutrophil count. A high-efficiency particulate air (HEPA) mask rather than a regular mask should be worn if the client is severely neutropenic (less than 100/mm3).
The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1. Restrict all visitors. 2. Restrict fluid intake. 3. Teach the client and family about the need for hand hygiene. 4. Insert an indwelling urinary catheter to prevent skin breakdown.
Answer: 3 Rationale: In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections. Test-Taking Strategy: Eliminate option 1 because of the closed-ended word all. Next, eliminate option 2 because it is not reasonable to restrict fluids in a client receiving chemotherapy who is at risk for fluid and electrolyte imbalances. Eliminate option 4 because of the risk of infection that exists with this measure.
Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse
D. 1 tsp salt in 1 L water mouth rinse A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.
The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A. Morphine sulfate B. Ibuprofen (Advil) C. Ondansetron (Zofran) D. Acetaminophen (Tylenol)
D. Acetaminophen (Tylenol) Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.
A pt has received a radiation implant. Which teaching point should the nurse emphasize with this pt? (Select all that apply) 1. "You will be placed in a private room" 2. "Do not wash off the skin markings made by the radiation therapist" 3. "Visitors and staff are restricted in the amount of time they can spend in your room" 4. "Your skin over the irradiated area may become irritated" 5. "Staff and visitors will maintain some distance from you while they are in your room"
1. "You will be placed in a private room" 3. "Visitors and staff are restricted in the amount of time they can spend in your room" 5. "Staff and visitors will maintain some distance from you while they are in your room"
To monitor pts who are taking antineoplastic drugs, the nurse must be aware that the most dangerous adverse effect is: 1. GI bleeding 2. Increased intracranial pressure 3. Bone marrow suppression 4. Nausea and vomiting
3. Bone marrow suppression Bone marrow suppression is the most dangerous side effect of antineoplastic drugs. Nausea and vomiting are likely to be the most distressing to patients because antineoplastic drugs simultaneously irritate the lining of the digestive tract and stimulate the vomiting center in the brain. Gastrointestinal bleeding is not a significant side effect of these drugs. Neurotoxic effects of these drugs are mostly associated with numbness and tingling of extremities, paralytic ileus, and loss of deep tendon reflexes but do not increase the patient's intracranial pressure.
The nurse is caring for a patient who is experiencing severe chemotherapy-induced nausea. Which actions can the nurse take to try to reduce the patient's nausea? (Select all that apply.) A. Instruct the patient to limit intake of spicy foods. B. Instruct the patient to avoid room temperature foods. C. Determine the best time for the patient to eat and drink. D. Encourage the patient to take small, frequent sips of water. E. Administer sedatives as ordered while antineoplastic drugs are being administered.
A. Instruct the patient to limit intake of spicy foods. C. Determine the best time for the patient to eat and drink. D. Encourage the patient to take small, frequent sips of water. E. Administer sedatives as ordered while antineoplastic drugs are being administered. Spicy foods can exacerbate nausea and should be avoided. Certain patients experience less nausea when eating at specific times, either before or after treatment. Small, frequent sips of water throughout the day help to reduce nausea and maintain hydration. Sedatives are sometimes ordered in conjunction with antineoplastic medications so the patient can sleep and to decrease the amount of time the patient is awake and nauseated. Patients should eat food at room temperature and should avoid extremely hot and cold foods.
Which of the following are nursing interventions for the patient problem of imbalanced nutrition: less than body requirements? (Select all that apply.) a. Provide adequate, easily digestible, soft, bland foods. b. Give small, frequent, highly nutritional meals. c. Allow extra time to eat. d. Offer three regular meals of highly nutritious foods.
ANS: A, B, C A patient problem of imbalanced nutrition: less than body requirements will require the nurse to give small, frequent, highly nutritional meals; to allow extra time to eat; and to provide adequate, easily digestible, soft, bland foods.
The nurse should include which food choice when providing dietary teaching for a patient scheduled to receive external beam radiation for abdominal cancer? a. Fresh fruit salad b. Roasted chicken c. Whole wheat toast d. Cream of potato soup
ANS: B To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products should also be avoided.
The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patients bedpan. b. The UAP stands by the patients bed for 30 minutes talking with the patient. c. The UAP places the patients bedding in the laundry container in the hallway. d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.
ANS: B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.
During a routine health examination, a 40-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Teach the patient about the need for a colonoscopy at age 50. b. Teach the patient how to do home testing for fecal occult blood. c. Obtain more information from the patient about the family history. d. Schedule a sigmoidoscopy to provide baseline data about the patient.
ANS: C The patient may be at increased risk for colon cancer, but the nurses first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning.
Which of the following are thrombocytopenic precautions? a. Requesting an order for aspirin for discomfort b. Trimming toenails close c. Using an electric razor d. Vigorous tooth cleaning
ANS: C The patient should be taught to use an electric shaver. Thrombocytopenia is a reduction in the number of circulating platelets, due to the depression of the bone marrow. When the platelet count is less than 20,000/mm3, spontaneous bleeding can occur.
A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate? a. Add strained baby meats to foods such as casseroles. b. Teach the patient about foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Add extra spice to enhance the flavor of foods that are served.
ANS: C The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. The patients poor intake is not caused by a lack of information about nutrition.
Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration? a. Teach the patient to rest the brain by avoiding new activities. b. Teach that chemo-brain is a short-term effect of chemotherapy. c. Report patient symptoms immediately to the health care provider. d. Suggest use of a daily planner and encourage adequate rest and sleep.
ANS: D Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop chemo-brain while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short- or long-term. There is no urgent need to report common chemotherapy side effects to the provider.
A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting this patients nutritional needs? A) Administration of parenteral feeds via a peripheral IV B) TPN administered via a peripherally inserted central catheter C) Insertion of an NG tube for administration of feeds D) Maintaining NPO status and IV hydration until treatment completion
Ans: B Feedback: If malabsorption is severe, or the cancer involves the upper GI tract, parenteral nutrition may be necessary. TPN is administered by way of a central line, not a peripheral IV. An NG would be contraindicated for this patient. Long-term NPO status would result in malnutrition.
The nurse is caring for a patient with a brain tumor. What drug would the nurse expect to be ordered to reduce the edema surrounding the tumor? A) Solumedrol B) Dextromethorphan C) Dexamethasone D) Furosemide
Ans: C Feedback: If a brain tumor is the cause of the increased ICP, corticosteroids (e.g., dexamethasone) help reduce the edema surrounding the tumor. Solumedrol, a steroid, and furosemide, a loop diuretic, are not the drugs of choice in this instance. Dextromethorphan is used in cough medicines.
The patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? A. Use Dial soap to feel clean and fresh. B. Scented lotion can be used on the area. C. Avoid heat and cold to the treatment area. D. Wear the new bra to comfort and support the area.
C. Avoid heat and cold to the treatment area. Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.
Realizing that chemotherapy can result in renal damage, the nurse should: a. encourage fluid intake to dilute the urine. b. take measures to acidify the urine and thus prevent uric acid crystallization. c. withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. d. limit fluids to 1,000 mL daily to prevent accumulation of the drugs' end products after cell lysis.
a. encourage fluid intake to dilute the urine.
The nurse should assess a cancer patient's nutritional status by: a. weighing the patient daily. b. monitoring daily calorie intake. c. observing for proper wound healing. d. doing all of the above.
a. weighing the patient daily.
What is stomatitis?
painful swelling and sore in your mouth (can be seen in chemo pt's)
