Onco
A client with bladder cancer undergoes surgical removal of the bladder with construction of an ileal conduit. What assessments by the nurse indicate that the client is developing complications? Select all that apply. 1. Urine output greater than 30 ml/hour 2. Dusky appearance of the stoma 3. Stoma protrusion from the skin 4. Mucus shreds in the urine collection bag 5. Edema of the stoma during the first 24 hours after surgery 6. Sharp abdominal pain with rigidity
2, 3, 6. A dusky appearance of the stoma indicates decreased blood supply; a healthy stoma should appear beefy-red. Protrusion indicates prolapse of the stoma, and sharp abdominal pain with rigidity indicates peritonitis. A urine output greater than 30 ml/hour is a sign of adequate renal perfusion and is a normal finding. Because mucous membranes are used to create the conduit, mucus in the urine is expected. Stomal edema is a normal finding during the first 24 hours after surgery.
A client with bladder cancer receives local radiation therapy and experiences a dry skin reaction. When teaching the client about skin care, the nurse should instruct the client to avoid: 1. lubrication. 2. cleansers. 3. cold packs. 4. cotton garments.
3. Cold packs over the area of a dry reaction to radiation therapy are contraindicated because they reduce capillary circulation to the site and hamper healing. Lubrication, cleansers, and cotton garments aren't unconditionally contraindicated.
A nurse is reviewing the diagnostic data of a client suspected of having gastric cancer. What laboratory finding is the nurse most likely to find? 1. Elevated levels of hemoglobin and hematocrit 2. Negative fecal occult blood test 3. Subnormal gastric hydrochloric acid level 4. Negative carcinoembryonic antigen (CEA) test
3. One manifestation of gastric cancer is achlorhydria, an absence of free hydrochloric acid in the stomach. In gastric cancer, a subnormal hemoglobin level and hematocrit is most likely; fecal occult blood test is most likely to be positive. The CEA test would most likely be positive in gastric cancer.
A client undergoes a circular skin punch biopsy to confirm a diagnosis of skin cancer. Immediately following the procedure, the nurse should observe the site for: 1. infection. 2. dehiscence. 3. hemorrhage. 4. swelling.
3. The nurse's main concern following a circular skin punch biopsy is to monitor for bleeding. Dehiscence is more likely in larger wounds such as surgical wounds of the abdomen or thorax. Infection is a later possible consequence of a skin punch biopsy and swelling is a normal reaction associated with any event that traumatizes the skin.
A client with thyroid cancer undergoes a thyroidectomy. After surgery, the client develops peripheral numbness and tingling and muscle twitching and spasms. The nurse should expect to administer: 1. thyroid supplements. 2. antispasmodics. 3. barbiturates. 4. I.V. calcium.
4. Removing the thyroid gland can cause hyposecretion of parathormone leading to calcium deficiency; indicated by numbness, tingling, and muscle spasms. Treatment includes calcium administration. Thyroid supplements will be necessary following thyroidectomy but aren't specifically related to the identified problem. Antispasmodics don't treat the problem's cause. Barbiturates aren't indicated.
A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client? a) Wear sterile gloves. b) Place incontinence pads in the regular trash container. c) Wear personal protective equipment when handling blood, body fluids, and feces. d) Provide a urinal or bedpan to decrease the likelihood of soiling linens
c) Wear personal protective equipment when handling blood, body fluids, and feces. Reason: Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Placing incontinence pads in the regular trash container and providing a urinal or bedpan don't protect the nurse caring for the client.
