Oncologic Disorders
A home care nurse assesses for disease complications in a client with bone cancer. The nurse knows that bone cancer may cause which electrolyte disturbance?
Hypercalcemia Explanation: In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia. Hyperkalemia isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia and hypomagnesemia are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.
A client with metastatic brain cancer is admitted to the oncology floor. According to the Patient Self-Determination Act of 1991 (PSDA), what is the hospital required to do concerning the execution of advance directives?
Inform the client or legal guardian of his right to execute an advance directive. Explanation: The PSDA of 1991 requires all health care facilities to notify clients upon admission of their right to execute an advance directive. The facility's ethics committee can decide on a treatment plan if the client is unable to do so, and a durable power of attorney hasn't been appointed. Hospitals aren't required by law to respect individuals' moral rights; however, health care professionals should do so as part of their professional responsibility. Health care professionals are sometimes concerned that advance directives prevent treatment that might help the client. However, the hospital shouldn't advise clients not to execute an advance directive.
A client is prescribed tamoxifen, 20 mg by mouth twice per day for treatment of breast cancer. The client reports to the nurse that she has worsening bone pain. How should the nurse respond
"Acute worsening of bone pain commonly indicates that the drug will produce a good response." Explanation: The nurse should reassure the client that acute worsening of bone pain commonly indicates that the drug will produce a good response. After reassuring the client, the nurse should offer pain medication to the client as prescribed. It isn't necessary to notify the physician unless the client requires a prescription for pain treatment. The nurse shouldn't hold a dose of the medication without a physician's order to do so.
The 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 guidelines, what information would be the most important for the nurse to give the women?
"Every women should have a mammogram every 2 years beginning at age 40" Correct response: "Women older than age 40 should have a mammogram and clinical examination every year" Explanation: The American Cancer Society guidelines state, "Women older than age 40 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.
A nurse is working with a client who is afraid of dying after a biopsy result came back positive for cancer. What is the best reflective response by the nurse to enhance client communication?
"You are afraid to die." Explanation: When communicating therapeutically with a client, the nurse must convey that the nurse understands and accepts what the client is thinking/feeling. Stating "Do not be afraid", "Everything will be okay", or "Everyone is afraid to die" conveys a negation of the client's thoughts and feelings. By reflecting back to the client, "You are afraid to die," the nurse is communicating a desire to understand the client's thoughts and feelings.
Several days before admission, a client reports finding a small lump in the left breast near the nipple. What should the nurse tell the client to do?
Inform the physician immediately. Explanation: The client should notify the physician immediately because a breast lump may be a sign of breast cancer. The client shouldn't squeeze the nipple to check for drainage until the physician examines the area. The client shouldn't wait until after her next menses to inform the physician of the breast lump because prompt treatment may be necessary. The client doesn't need to place a heating pad on the area because it would have no effect on a breast lump.
A client visits the gynecologist reporting pain during sexual intercourse. The physician orders include a Pap smear. The nurse is interviewing the client as part of her assessment. Which statement by the client would be most important for the nurse report to the physician?
"I had a human papillomavirus infection at age 32." Explanation: Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.
The nurse is interviewing a client suspected of having colon cancer about his past medical history. Which statement by the client should the nurse report to the physician?
"I had some polyps removed last time I had a colonoscopy." Explanation: 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.
A client is scheduled for a surgical procedure for removal of a pancreatic tumor. The client states to the nurse, "I don't think I'll live through the surgery. I'm scared." What is the best response by the nurse?
"Let's talk about your concerns and fears." Explanation: The client is expressing concerns and fears related to having a serious surgical procedure; the most therapeutic response the nurse can give is to let the client know that she is not alone and someone is present to talk to about the feelings she is having. Telling the client that not everyone makes it through surgery does not address the client's fears and can make the anxiety about the procedure worse. Advising the client to say goodbye to her family also does not respond to the fears and lends finality to the situation. Discussing what the nurse felt when having surgery does not address the client's concern.
What is the most important postoperative instruction the nurse must give a client who has just returned from the operating room after receiving a subarachnoid block? .
"Remain supine for the time specified by the physician." Correct response: "Remain supine for the time specified by the physician." Explanation: The nurse should instruct the client to remain supine for the time specified by the physician. Local anesthetics used in a subarachnoid block don't alter the gag reflex. No interactions between local anesthetics and food occur. Local anesthetics don't cause hematuria.
The nurse is teaching a group of men about prostate health. Which of the following would be most important for the nurse to tell the men?
"Starting at age 50, men should talk to a doctor about the pros and cons of PSA testing so they can decide if testing is the right choice for them" Explanation: Risk factors for prostate cancer include age older than 40, a diet high in saturated fats (not carbohydrates), and hormonal factors (testosterone may initiate or promote prostate cancer). Poverty and a history of infertility aren't associated with prostate cancer.
A nurse walks into the room of a client who has had surgery for testicular cancer. The client becomes quiet and tearful after telling the nurse, "I'm afraid that now I will be undesirable to my wife." Which response by the nurse is most appropriate?
"Tell me more about how you are feeling." Explanation: The client who has had surgery for testicular cancer and fears being undesirable to his wife should be encouraged to discuss his feelings. Gathering information about the meaning of "undesirable" does not allow the client to open up to talk about his feelings. Reassuring the client that his wife will understand does not assist with opening a dialogue with the client. Interpreting what the client means by undesirable is not appropriate.
The nurse is caring for a client who detected a lump in her right breast. The client asks the nurse " How do I find out if it's cancer?" Which statement by the nurse would be most appropriate?
"The physician will need to perform a fine needle aspiration and biopsy to confirm the diagnosis. Explanation: Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.
As part of a primary cancer prevention program, an oncology nurse speaks to the public at a health fair. When someone asks about laryngeal cancer, which statement by the nurse would be most helpful?
"To reduce the risk of developing laryngeal cancer you shouldn't smoke or drink alcohol." Explanation: Laryngeal cancer is one of the most preventable types of cancer; it can be prevented by abstaining from excessive drinking and smoking. Inhaling noxious fumes, such as in polluted air, is a risk factor for laryngeal cancer. Roughly 80% of laryngeal cancer cases occur in men. Squamous cell carcinoma accounts for most cases of laryngeal cancer.
A client in the final stages of terminal cancer tells the nurse, "I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I continue my chemotherapy and radiation treatments only because my family wants me to." How should the nurse respond?
"Would you like to meet with your family and health care provider about this matter?" Explanation: Nurses have a moral and professional responsibility to advocate for clients who experience decreased independence, loss of freedom of action, and interference with their ability to make autonomous choices. Coordinating a meeting between the primary care provider and family members may allow the client an opportunity to express his wishes and promote awareness of his feelings, as well as influence future care decisions. All of the other responses by the nurse are inappropriate.
During a breast examination, which finding most strongly suggests that the client has breast cancer?
A fixed nodular mass with dimpling of the overlying skin Explanation: A fixed nodular mass with dimpling of the overlying skin is common during late stages of breast cancer. Many women have slightly asymmetrical breasts. Bloody nipple discharge is a sign of intraductal papilloma, a benign condition. Multiple firm, round, freely movable masses that change with the menstrual cycle indicate fibrocystic breasts, a benign condition.
The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?
Asymmetry Explanation: When following the ABCD method for assessing skin lesions, the A stands for "asymmetry," the B for "border irregularity," the C for "color variation," and the D for "diameter."
A client is undergoing tests for multiple myeloma. Which diagnostic finding would the nurse expect to see in multiple myeloma?
Bence Jones protein in the urine Explanation: Presence of Bence Jones protein in the urine almost always confirms the diagnosis of multiple myeloma; however, absence of the protein does not rule the disease out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum creatinine level may also be increased. Serum electrophoresis shows an elevated globulin spike, not a decreased serum protein level.
A 45-year-old client receiving radiation therapy for thyroid cancer reports mouth and throat pain. While inspecting the mouth and throat, the nurse notices white patches and ulcerations in the oral mucosa. What do these findings suggest?
Candidiasis Explanation: White patches and ulcers in the mouth and throat suggest candidiasis. Candidiasis is common in immunocompromised clients and in clients receiving radiation therapy. Xerostomia, radiation caries, and dysphagia are adverse effects of radiation therapy, but they don't involve white patches or ulcerations.
The nurse in a long-term care facility notes a change in the color, shape, and texture of a nevus located on a client's shoulder. The nurse knows that this finding might suggest:
Correct response: malignant melanoma. Explanation: A change in a nevus is a sign of malignant melanoma, not a sign that the nevus is healing. Multiple myeloma produces vision disturbances, headaches, somnolence, irritability, confusion, cold intolerance, renal failure, and skeletal pain. Findings associated with acute leukemia include, infection, fever, bleeding, anemia, malaise, fever, lethargy, paleness, weight loss, and night sweats
The nurse is caring for a client who was admitted with rectal bleeding. The client is at high risk for having colorectal cancer. The nurse anticipates the physician will order which diagnostic test to confirm this suspicion?
Explanation: Used to visualize the lower GI tract, colonoscopy aids in detecting two-thirds of all colorectal cancers. Stool Hematest detects blood, which is a sign of colorectal cancer; however, the test doesn't confirm the diagnosis. CEA may be elevated in colorectal cancer but isn't considered a confirming test. An abdominal CT scan is used to stage the presence of colorectal cancer.
A client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the client's right arm, and the left arm and hand should be elevated as much as possible to prevent which condition?
Lymphedema Explanation: Lymphedema is a common postoperative adverse effect of modified radical mastectomy and lymph node dissection. Elevation of the arm on the affected side will allow gravity to assist lymph drainage. Other preventive measures include exercises in which the arms are elevated. Trousseau sign is a sign of hypocalcemia and wouldn't be expected in this situation. Neither intravenous infusions nor venipunctures should be given in the left arm. Although muscle atrophy is a potential adverse effect if the client doesn't exercise her left arm, it wouldn't be prevented by elevating the arm.
The nurse is caring for a client with bronchogenic carcinoma. Which nursing interventions are essential in the care of the client receiving a chemotherapeutic regimen? Select all that apply. You Selected: Maintain a patent airway. Instruct the client on signs and symptoms of infection. Alleviate anxiety by explaining procedures and care delivery.
Maintain a patent airway. Alleviate anxiety by explaining procedures and care delivery. Instruct the client on signs and symptoms of infection. Explanation: Maintaining a patent airway is the first concern in caring for a client with a condition that may compromise the airway. Therefore, ineffective airway clearance related to obstruction by a tumor or secretions takes highest priority and should be monitored at all times, especially during chemotherapy. All care should be explained prior to performing to help alleviate the client's anxiety related to the care. The client may not tolerate full meals and should be encouraged to eat several small meals in the day to maintain nutritional balance. Infection can be detrimental to the therapeutic regimen and should be closely monitored. The client should be informed of the signs and to report them to the health care professional immediately. Because not all clients tolerate the same types of chemotherapy, false reassurance should not be used.
A client with advanced cancer of the mouth has a swollen, necrotic, and weeping tongue. Which nursing intervention should be a priority in planning care?
Maintain a patent airway. Explanation: In a client with advanced mouth cancer, the priority nursing concerns are maintaining a patent airway and monitoring for signs of hemorrhage. Essential nursing measures include aspirating the client's oral secretions and maintaining a side-lying position to keep the airway open. The other options are important, but they are not the priority.
On a visit to the gynecologist, a client reports 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?
Major surgery Explanation: 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.
Which intervention is appropriate for the nurse caring for a client in severe pain receiving a continuous I.V. infusion of morphine?
Obtaining baseline vital signs before administering the first dose Explanation: The nurse should obtain the client's baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a opioid antagonist, not an opioid agonist. The nurse shouldn't discontinue an opioid agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.
Which finding is an early indicator of bladder cancer?
Painless, intermittent hematuria Explanation: As cancer cells destroy normal bladder tissue, bleeding occurs and causes painless, intermittent hematuria. (Pain is a late symptom of bladder cancer.) The other options aren't associated with bladder cancer. Occasional polyuria may occur with diabetes or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection (UTI)
After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer?
Pituitary carcinoma most commonly arises in the anterior pituitary (adenohypophysis) and must be removed by way of a transsphenoidal approach, using a bivalve speculum and rongeur. Esophageal carcinoma is treated with surgery, which usually is palliative and involves esophagogastrectomy with jejunostomy. Laryngeal carcinoma may necessitate a laryngectomy. To treat colorectal carcinoma, the surgeon removes the tumor and any adjacent tissues and lymph nodes that contain cancer cells.
A client has been receiving chemotherapy to treat cancer. Which data collection finding suggests that the client has developed stomatitis (inflammation of the mouth)?
Red, open sores on the oral mucosa Explanation: The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.
The nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?
Refer the client to the American Cancer Society's (Canadian Cancer Society's) Reach for Recovery program or another support program. Explanation: The client isn't withdrawn and doesn't show other signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences, either through Reach for Recovery or another formal support group. The nurse may educate the client's spouse or partner and listen to his concerns, but the nurse shouldn't tell the client's spouse what to do. The client must consult with her physician and make her own decisions about further treatment. The client needs to express her sadness, frustration, and fear. She can't be expected to be cheerful at all times
A client in the terminal stage of cancer is receiving a continuous infusion of morphine for pain management. Which data collection finding suggests that the client is experiencing an adverse effect of this drug?
Respiratory rate of 8 breaths/minute Explanation: A respiratory rate of 8 breaths/minute is below normal and suggests respiratory depression, a common adverse effect of morphine. Voiding 350 ml of concentrated urine in 8 hours signals dehydration, and an irregular heart rate of 82 beats/minute signals a cardiac problem — neither of which typically results from morphine. Constricted and equal pupils are an expected, but not necessarily adverse, effect of opioids.
A nurse is preparing a client for discharge after a prolonged hospitalization in which the client had a colon resection and colostomy formation for treatment of colon cancer. The client's family has concerns about managing his care at home. Which factor is most important in ensuring successful home care?
Support from friends and family Explanation: Home care success depends on a key factor: support from friends and family. Ability to care for the colostomy, the client's age, and the complexity of his care aren't as important to the success of home care as is the support from friends and family.
The nurse is teaching a group of men about prostate health. Which of the following would be most important for the nurse to tell the men? You Selected: "Starting at age 50, men should talk to a doctor about the pros and cons of PSA testing so they can decide if testing is the right choice for them" Correct response: "Starting at age 50, men should talk to a doctor about the pros and cons of PSA testing so they can decide if testing is the right choice for them" Explanation: Risk factors for prostate cancer include age older than 40, a diet high in saturated fats (not carbohydrates), and hormonal factors (testosterone may initiate or promote prostate cancer). Poverty and a history of infertility aren't associated with prostate cancer.
You Selected: "Starting at age 50, men should talk to a doctor about the pros and cons of PSA testing so they can decide if testing is the right choice for them" Explanation: Risk factors for prostate cancer include age older than 40, a diet high in saturated fats (not carbohydrates), and hormonal factors (testosterone may initiate or promote prostate cancer). Poverty and a history of infertility aren't associated with prostate cancer.
A multidisciplinary oncology team notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply.
decreased white blood cells decreased platelets decreased red blood cells Explanation: Pancytopenia is a deficiency of all blood cells, which includes a state of simultaneous leukopenia (decreased white blood cells), thrombocytopenia (decreased platelets), and anemia (decreased red blood cells). Pancytopenia has widespread effects on the body by leading to oxygen shortage and impaired immune function.
A nurse is reinforcing education with the parent of an ill child about childhood immunizations. The nurse should tell the parent that only inactivated virus vaccines should be administered to children with which disorder?
leukemia Explanation: Leukemia causes immunosuppression, so inactivated (rather than live) viruses should be administered. Children with diabetes, asthma, and cystic fibrosis can receive live virus vaccines because these conditions do not cause immunosuppression.
A nurse is collecting past medical history data on a client. Which preexisting condition places the client at risk for colorectal cancer?
polyps Explanation: Although not all colorectal polyps are cancerous, polyps are a common finding in colon cancer. Duodenal ulcers and hemorrhoids are not associated with colorectal cancer. Weight loss, not gain, is an indication of colorectal cancer.
