Oncology Q's
The nurse recognizes which symptom is an early indication of gastric cancer? A. Occult blood in the stool B. Vomiting C. Iron deficiency anemia D. Abdominal discomfort relieved with antacids
D. Abdominal discomfort relieved with antacids All of the other options presented here are signs of advanced gastric cancer. Abdominal discomfort relieved with antacids is a sign of early gastric cancer. Other early indications of gastric cancer include indigestion, loss of appetite, bloated feeling, weight loss, and difficulty swallowing.
The nurse provides care for a 64 y/o client in the outpatient clinic. Nurse's notes: 64 y/o client presents to the clinic with reports of increasing fatigue and unintentional weight loss of "about 15 lbs in the last month or so." Health maintenance includes annual physicals, prostate exam, PSA, EKG, chest x-ray, as required by his company. Last colonoscopy was 12 years ago and according to the client, was "normal." Currently works as a long haul trucker. Occasional alcohol use. Has smoked cigars off and on for 20 years to "keep me awake at night, when I'm driving." Admits diet is "not very good" when on the road; lots of fast food and very few fruits and vegetables. Client admits to having noticed blood in the toilet after bowel movements "for a few weeks." VS: Oral temperature: 98.8 F (37.8 C) HR: 82 RR: 16 BP: 168/98 Oximetry: 98% on room air Height: 5'9" (1.75 m) Weight: 219 lbs (99.3 kg) The client is ready for discharge after their hemicolectomy. Final pathology is pending. Follow up appointment with surgeon in one week. Appointment for referral to oncology in 2 weeks. For each statement made by the client, identify whether it does or does not demonstrate understanding of the discharge instructions provided. - "I may need chemotherapy, but that will be determined by the oncologist." - "My bowel movements will never be normal again." - "The final pathology will determine the stage of my cancer." - "Bright red blood in my stool is normal after surgery." - "I can advance my diet to a regular diet." - "I will follow my surgeon's instructions about activity and when to return to work."
- "I may need chemotherapy, but that will be determined by the oncologist." - understanding - "My bowel movements will never be normal again." - NO understanding - "The final pathology will determine the stage of my cancer." - understanding - "Bright red blood in my stool is normal after surgery." - NO understanding - "I can advance my diet to a regular diet." - understanding - "I will follow my surgeon's instructions about activity and when to return to work." - understanding BMs return to normal within a few weeks of surgery, and bright red blood in the stool is never normal or expected.
The parents of an infant client diagnosed with cryptorchidism ask the nurse, "In which situation would orchiopexy be recommended for our baby?" Which is the best response by the nurse? A. "If the testicle has become cancerous." B. "If the child has limited ability to walk." C. "If the child has issues with toilet training." D. "If the other testicle retracts in response to cold."
A. "If the testicle has become cancerous." Cryptorchidism is a failure of the testicle to descend from the trunk of the body. If not corrected, this can result in infertility. Orchiopexy is a surgery to move an undescended testicle into the scrotum and permanently fix it there. Because there's a high possibility of undescended testicles becoming cancerous, an orchiopexy would be done if that is the case. Undescended testicles don't affect one's ability to walk or be continent. Testicle retraction in response to the cold is a normal response by this organ, as caused by spasm of the cremaster muscle.
The nurse provides care for an older adult client with a diagnosis of cancer. The client is obese, has a history of cigarette smoking, and drinks alcohol. Which risk factor for cancer is non-modifiable? A. Advancing age B. Smoking tobacco C. Drinking alcohol D. Obesity
A. Advancing age You can't change how old you get. Risk of cancer increases significantly after age 50 and 50% of all cancers occur in people 65+ y/o. Other examples of non-modifiable RFs would be family hx, gender, ethnicity. You can control all the other factors - whether you smoke cigarettes, whether you drink alcohol, and how you eat and exercise in relation to weight. Tobacco is a carcinogen that contributes to lung, pharyngeal, esophageal, cervical, bladder, pancreatic, and kidney cancer. Alcohol contributes to cancer of the liver. Alcohol and tobacco enhance the carcinogenic activity of each other. Obesity increases risk of getting a variety of cancers.
The home health care nurse visits a client undergoing teletherapy for treatment of breast cancer. It is most important for the nurse to include which intervention in the client's plan of care? Select all that apply. A. Gently cleanse the irradiated area with mild soap and water. B. Apply cream to the irradiated area daily. C. Avoid exposure of the irradiated area to the sun. D. Use a patting motion to dry the irradiated area. E. Wear tight, heavy synthetic clothing to protect the area.
A. Gently cleanse the irradiated area with mild soap and water. C. Avoid exposure of the irradiated area to the sun. D. Use a patting motion to dry the irradiated area. Washing the irradiated area (the area that received the radiation) daily with mild soap and water is an appropriate component in patient education in this scneario. It should only be done with hands. The area shouldn't be exposed to sun or heat at any time (not just something you avoid, don't get any at all). After washing, the area should be patted dry with a soft towel or cloth. The client shouldn't use any powders, ointments, lotions, or creams on the irradiated areas. Any clothing you wear should be loose, made of soft cotton (not binding or rubbing).
Which nursing intervention is most effective in promoting adequate nutrition for clients undergoing radiation and chemotherapy? A. Include clients when making meal and snack selections B. Ensure meals are served hot C. Offer salty snacks every 2 hrs D. Serve additional portions of food at mealtime
A. Include clients when making meal and snack selections Clients should be included in meal and snack selection as much as possible. The nurse should assist clients to identify foods that are appealing and offer small, frequent feedings of nutrient-dense food. Cold foods or foods served at room temp are better tolerated by this demographic of patients than hot foods. Salty snacks aren't nutrient rich and consequently don't help promote adequate nutrition. Serving additional portions wouldn't be the most effective way in general of assuring adequate nutrition because patients going thru chemo and radiation usually have decreased appetite, so you should focus on helping them eat as healthily as they can with as much as they're able to tolerate eating.
The nurse provides care for a 64 y/o client in the outpatient clinic. Nurse's notes: 64 y/o client presents to the clinic with reports of increasing fatigue and unintentional weight loss of "about 15 lbs in the last month or so." Health maintenance includes annual physicals, prostate exam, PSA, EKG, chest x-ray, as required by his company. Last colonoscopy was 12 years ago and according to the client, was "normal." Currently works as a long haul trucker. Occasional alcohol use. Has smoked cigars off and on for 20 years to "keep me awake at night, when I'm driving." Admits diet is "not very good" when on the road; lots of fast food and very few fruits and vegetables. Client admits to having noticed blood in the toilet after bowel movements "for a few weeks." VS: Oral temperature: 98.8 F (37.8 C) HR: 82 RR: 16 BP: 168/98 Oximetry: 98% on room air Height: 5'9" (1.75 m) Weight: 219 lbs (99.3 kg) Which health care order does the nurse anticipate? Select all that apply. A. Referral to gastroenterology for a colonoscopy. B. 24 hour diet recall. C. Referral to cardiology for an electrocardiogram. D. CBC E. CMP F. 24 hour urine collection G. Low dose CT scan H. Bedrest for one week I. High protein diet J. Smoking cessation education
A. Referral to gastroenterology for a colonoscopy. D. CBC E. CMP G. Low dose CT scan J. Smoking cessation education It's not clear what's going on with this client d/t their presentation. However, it is evident that the client is due for a colonoscopy. The CBC and CMP may identify a cause for the fatigue and weight loss. The smoking hx qualifies the client for a low dose CT scan, and every client who smokes should receive smoking cessation education. Diet modifications are not needed at this time and there's no indication the client needs to do a 24 hr diet recall. There's enough information to know that the client might benefit from some dietary changes, but those don't take priority right now. There's no sign of cardiac problems or that the last EKG was abnormal, so a cardiac referral isn't needed. There's no indication that the client needs bedrest. It's unlikely that a 24 hour urine would be useful at this point.
Ondansetron HCl 6 mg PO q6hr is prescribed for a client receiving chemotherapy. The nurse knows which time is the most appropriate to administer this medication? A. 1 hour after chemotherapy B. 30 minutes prior to the start of chemotherapy C. 2 hours after chemotherapy D. After the client reports nausea
B. 30 minutes prior to the start of chemotherapy Ondansetron has a 30-40 min onset of action, so if you take it 30 min before starting the chemo, the med will be active and help prevent/negate n/v. Side fx of this med include constipation, diarrhea, fever, lightheadedness, and drowsiness. Ondansetron prevents, not treats, n/v - prevention meaning you take the med before and treat meaning you take the med after x event.
The nurse recognizes which sign as an indication of cancer of the larynx? A. Increased drooling B. Blood-streaked sputum C. Difficulty swallowing D. Jaundice
C. Difficulty swallowing Hoarseness, difficulty swallowing, color changes in the mouth or tongue, and oral lesions that don't heal are warning signs of laryngeal cancer. Cancers of the brain can cause drooling. Lung cancer can cause hemoptysis. Liver or pancreatic cancer can cause jaundice.
The home health care nurse monitors a client diagnosed with cancer of the lung. The client reports awakening with a severe headache several mornings during the past week. The client also admits to becoming suddenly nauseated and reports drooling and vomiting. Which action by the nurse is best? A. Administer the prescribed antiemetic B. Reassure the client that this is expected C. Assess the status of the client's lungs D. Contact the health care provider
D. Contact the health care provider The combination of sx - multiple occurrences of severe HAs, sudden sensations of n/v, drooling - warrant a complete neurological assessment after which you should contact the provider. This is because the most common sites of metastasis for lung cancer are the other lung (that's unaffected - this refers to how usually one lung develops the cancerous tissue and then it can spread to the other lung which didn't have cancerous tissue at the initial time of dx), adrenal gland, bones, brain, and liver. The concern here is that maybe these sx can be attributed to metastasis of the lung cancer to the brain. Because the concern here is metastasis of the lung cancer to the brain, your top priorities are to complete a full neuro assessment and contact the provider. N/v that is d/t brain metastasis might not be controlled with antiemetics, so this should be a secondary priority here. Give the antiemetic after the neuro assessment and contacting the provider. It is not expected to have severe HAs when waking up, nor sudden n/v. This indicates a likely complication of lung cancer and should be reported immediately. Conducting a lung assessment is an appropriate action bc of how the patient has lung cancer (so you want to assess present lung function) but is a secondary priority that can be done along with administering the prescribed antiemetic, given how, again, sx of metastasis need to be investigated ASAP.
The nurse helps a client diagnosed with cancer make a plan for regaining weight that was lost during antineoplastic therapy. Which food does the nurse suggest to provide the highest protein and calorie intake? A. Oatmeal cookie with raisins B. Liver and onions C. Low fat yogurt and fruit D. Peanut butter and banana sandwich
D. Peanut butter and banana sandwich The cookie may have calories and the raisins do contain iron, but the cookie has little protein value. Liver contains protein and is a good source of iron, but liver and onions is not a high calorie food. Milk products are a good source of protein but low fat yogurt and fruit is not high in calories. The client should be encouraged to use whole milk, cheese, and yogurt made with whole milk in order to have the most caloric intake. Peanut butter is a good source of protein and calories. The carbohydrates in bananas and bread also increase the caloric value. Other foods which provide high protein and increased calories include ice cream, eggnog, cheese, cream cheese, avocados, mayonnaise, nuts, and meats and some vegetables prepared in butter and oil.
The nurse makes a home care visit to a client receiving chemotherapy for treatment of cancer. The client's WBC count is 3,500/mm^3 (3.5 x 10^9/L). Which observation, if made by the nurse, requires an intervention? A. The client cleans the toothbrush daily by washing it in the dishwasher. B. The client eats fruits and vegetables after washing them. C. The client takes and records the oral temperature each day. D. The client pulls weeds in the garden every day.
D. The client pulls weeds in the garden every day. The question is asking you which option you need to correct the patient on. Digging in the garden or working with houseplants isn't advised for people who are immunocompromised. Normal WBC rage is 4.5K-11K/mm^3 (4.5-11 x 10^9/L). A value less than that indicates the body may not be able to fight infection. The other options provided are correct and do not need intervention from the nurse. Because the patient's WBC levels are low, indicating that they're immunocompromised, cleaning the toothbrush in the dishwasher daily is a good practice because it prevents bacteria from growing on the brush. As per standard food safety practices, everyone should only eat fruits and vegetables after washing them. It's good to monitor temperature daily because any sign of infection should be reported to one's provider immediately.
The nurse provides care for a 64 y/o client in the outpatient clinic. Nurse's notes: 64 y/o client presents to the clinic with reports of increasing fatigue and unintentional weight loss of "about 15 lbs in the last month or so." Health maintenance includes annual physicals, prostate exam, PSA, EKG, chest x-ray, as required by his company. Last colonoscopy was 12 years ago and according to the client, was "normal." Currently works as a long haul trucker. Occasional alcohol use. Has smoked cigars off and on for 20 years to "keep me awake at night, when I'm driving." Admits diet is "not very good" when on the road; lots of fast food and very few fruits and vegetables. Client admits to having noticed blood in the toilet after bowel movements "for a few weeks." VS: Oral temperature: 98.8 F (37.8 C) HR: 82 RR: 16 BP: 168/98 Oximetry: 98% on room air Height: 5'9" (1.75 m) Weight: 219 lbs (99.3 kg) For each finding below, identify whether it is or is not a risk factor for colon cancer (yes or no for each). - sedentary lifestyle - diet high in processed foods - obesity - alcohol use - hypertension
- sedentary lifestyle: yes - diet high in processed foods: yes - obesity: yes - alcohol use: yes - hypertension: no RF for colon cancer include obesity, sedentary lifestyle, diet high in fat and processed foods, low in fresh fruits and veggies, smoking, and alcohol use.
The nurse provides care for a client diagnosed with cancer who is receiving chemotherapy. The client shares with the nurse how upsetting losing hair will be. Which statement by the nurse is best? A. "Wear a wig; I think a wig will look nice on you." B. "I understand, I would not want to lose my hair!" C. "It is okay to be upset. Let's discuss the different head cover options and the process of hair regrowth after chemotherapy." D. "Wearing attractive hats and scarves won't be that bad."
C. "It is okay to be upset. Let's discuss the different head cover options and the process of hair regrowth after chemotherapy." This is the only option that practices therapeutic communication. It provides information, empathy, and education to the patient all at once. The other options are non-therapeutic communication. The first option negates the client's feelings and also offers an opinion. The second option puts the focus on the nurse and not the clients. The last option again negates the client's feelings and offers the nurse's opinion.
The nurse recognizes which symptom is an early indication of gastric cancer? A. Occult blood in the stool B. Vomiting C. Iron deficiency anemia D. Abdominal discomfort relieved with antacids
D. Abdominal discomfort relieved with antacids Early signs of gastric cancer include abdominal discomfort that's relieved with antacids, indigestion, loss of appetite, bloated feeling, weight loss, and difficulty swallowing. All of the other signs listed - occult blood in stool, vomiting (especially vomiting blood or dark material that looks like coffee grounds), and iron deficiency anemia - indicate advanced gastric cancer (later in the disease process). GI bleeds are a/w gastric cancer as well.
The nurse provides care for a 64 y/o client in the outpatient clinic. Nurse's notes: 64 y/o client presents to the clinic with reports of increasing fatigue and unintentional weight loss of "about 15 lbs in the last month or so." Health maintenance includes annual physicals, prostate exam, PSA, EKG, chest x-ray, as required by his company. Last colonoscopy was 12 years ago and according to the client, was "normal." Currently works as a long haul trucker. Occasional alcohol use. Has smoked cigars off and on for 20 years to "keep me awake at night, when I'm driving." Admits diet is "not very good" when on the road; lots of fast food and very few fruits and vegetables. Client admits to having noticed blood in the toilet after bowel movements "for a few weeks." VS: Oral temperature: 98.8 F (37.8 C) HR: 82 RR: 16 BP: 168/98 Oximetry: 98% on room air Height: 5'9" (1.75 m) Weight: 219 lbs (99.3 kg) Identify all of the concerning findings in the nurse's note above.
- increasing fatigue and unintentional weight loss - last colonoscopy was 12 years ago (and the patient is 64) - they're overdue for another one - occasional alcohol use - has smoked cigars off and on for 20 yrs - lots of fast food and very few fruits and vegetables when on the road - blood in the toilet after bowel movements noticed for the past few weeks The client's occupation of long haul trucker is problematic for how it causes them to have a sedentary lifestyle and not exercise much d/t sitting for long periods of time, but the occupation itself isn't inherently a cause for concern.
A client is scheduled for a total laryngectomy. The client tells the nurse, "I am worried about my operation. I just can't help it." Which response by the nurse is best? A. "Have you discussed your worries with your health care provider?" B. "What is your biggest worry at the moment?" C. "You have a really fine health care provider so there seems to be little need to worry." D. "Everyone worries about surgery, especially when it is a first time experience."
B. "What is your biggest worry at the moment?" The nurse's response acknowledges the client's thoughts, feelings, and needs (validation). Additionally, the response is seeking additional information (assessment) to determine what the client needs (information, clarification) to feel prepared for the surgery. Patients can and should talk to their nurses about any worries or concerns about their upcoming operations. Depending on what the patient says, the nurse should determine whether the provider needs to be contacted or not. For the third option, false reassurance is a non-therapeutic communication technique, discouraging open communication and expression of feelings. The fourth is an example of a non-therapeutic communication technique called "automatic responses." This stereotypical response communicates to the client that you're not taking the client's concern seriously or responding thoughtfully.
The nurse provides care for a 64 y/o client in the outpatient clinic. Nurse's notes: 64 y/o client presents to the clinic with reports of increasing fatigue and unintentional weight loss of "about 15 lbs in the last month or so." Health maintenance includes annual physicals, prostate exam, PSA, EKG, chest x-ray, as required by his company. Last colonoscopy was 12 years ago and according to the client, was "normal." Currently works as a long haul trucker. Occasional alcohol use. Has smoked cigars off and on for 20 years to "keep me awake at night, when I'm driving." Admits diet is "not very good" when on the road; lots of fast food and very few fruits and vegetables. Client admits to having noticed blood in the toilet after bowel movements "for a few weeks." VS: Oral temperature: 98.8 F (37.8 C) HR: 82 RR: 16 BP: 168/98 Oximetry: 98% on room air Height: 5'9" (1.75 m) Weight: 219 lbs (99.3 kg) For each assessment finding below, identify whether it's associated with colon cancer, CAD, or lung cancer. Each finding may be associated with more than one disease process. Each disease process must have at least one option selected for it. - increasing fatigue - unintentional weight loss - blood in stool for 3 weeks - blood pressure 168/98
- increasing fatigue: CAD, lung cancer - unintentional weight loss: colon cancer, lung cancer - blood in stool for 3 weeks: colon cancer - blood pressure 168/98: CAD Increasing fatigue and unintentional weight loss are sx a/w most solid tumor cancers, including lung and colon. Blood in the toilet or in the stool after a BM can be a sign of colon cancer; blood on toilet tissue after a BM is more often a/w hemorrhoids. HTN is a RF for CAD. Some of the sx could be considered non-specific, but when you put them together (fatigue, weight loss, blood in the stool), these sx should be investigated for colon cancer.
The home health nurse provides care for a client diagnosed with acute myelogenous leukemia (AML). The client's temperature is 101 F (38.3 C). Which action does the nurse take first? A. Notifies the health care provider B. Offers the client oral fluids C. Administers an antipyretic D. Encourages the client to cough and deep breathe
A. Notifies the health care provider People with AML are immunocompromised bc of the disease process they're affected by, consequently putting them at risk of infection. Because being immunocompromised means you present atypically with infection, any sign of infection needs to be deemed as emergent and txed immediately. The nurse will assess for possible causes of infection by inspecting wounds, skin, mucous membranes for redness, swelling, and drainage; assessing lung sounds; and noting urine output, appearance, and odor. Because fever is a sign of infection, and infection should always be txed immediately in immunocompromised patients, that is your top priority as the nurse. Each of the other interventions are secondary priorities. Pushing fluids is important for txing infection but will not directly and most potently address the source of the infection (meds like antimicrobials do that). Administering an antipyretic may alleviate client discomfort, but will not address the source of the infection. The provider should be notified first before an antipyretic is given. Coughing and deep breathing will help prevent lung infection, but this again is a secondary priority to notifying the provider. Additionally, the question is looking for reactive measures here and this is a more proactive measure against infection. Also, at this point, you don't even know what kind of infection the patient has. The health care provider will rx antibiotic, antifungal, and/or antiviral therapy. Wound, urine, or blood cultures may need to be obtained.
A client diagnosed with laryngeal cancer undergoes a total laryngectomy. The client returns from the operating room (OR) with a nasogastric tube in place. The nurse identifies the NG tube is in place for which reason? A. Prevention of trauma to the surgical area and maintenance of nutritional status allow for healing B. Postoperative incision pain will make eating and drinking regular foods very uncomfortable C. The client will have altered body image due to diminished facial motor control, which makes food intake difficult D. The client will need low protein nourishment, which tube feeding provides more effectively than eating regular dietary products
A. Prevention of trauma to the surgical area and maintenance of nutritional status allow for healing The NG tube does assist with easing incision pain and discomfort, but that's not its primary purpose. The client retains facial motor control after surgery, given that the surgical area was the larynx (in the throat). Altered body image and diminished facial motor control are not what cause difficulty with food intake, it's pain. The client needs a high protein diet, not a low protein diet, in order to assist with rebuilding tissue after surgery. The NG tube is utilized to prevent damage to the suture line. Additionally, nutritional needs are increased due to surgical procedure. An enteral tube feeding will maintain nutritional status, thus enabling healing and easing discomfort that would be caused by manually doing it. As well, the NG tube makes sure that the edema in the area will not cause the client to accidentally aspirate if trying to eat or drink.
The nurse makes a home visit to a client receiving chemotherapy for the treatment of cancer. The nurse instructs the client about ways to avoid injury due to bone marrow suppression. The nurse intervenes if which observation is made? A. The client takes aspirin for arthritis pain B. The client uses an electric razor to shave C. The client blows the nose gently D. The client reports adding fiber to the diet
A. The client takes aspirin for arthritis pain Chemo causes bone marrow suppression. Remember that both RBCs and WBCs are produced in bone marrow, so bone marrow suppression causes decreased WBCs and decreased RBCs. Decreased RBCs means that the patient is a bleeding risk, which in turn, means that they should be placed on bleeding precautions - one of which is to not take aspirin or other antiplatelet/anticoagulant medications since these will only heighten the bleeding risk in these patients. All of the other options listed here are appropriate bleeding precautions. Using an electric razor instead of a manual razor decreases risk of trauma to the skin. Because bleeding can occur from anywhere, like the nose, gums, or mouth, patients on bleeding precautions should blow their nose gently to prevent trauma. Also avoid blocking either nasal passage while blowing to reduce the risk of nasal mucosa trauma and ICP. Adding fiber (bulk) to the client's diet will prevent trauma to the rectal mucous from straining. Additional bleeding precautions include using a soft toothbrush or toothette for mouth care, avoiding commercial mouthwashes (dry out oral mucosa), and avoiding contact sports/activities.
The nurse provides care for a client postoperatively after a Whipple procedure for treatment of pancreatic cancer. The nurse is most concerned if which observation is made? A. There is clear, colorless, bile-tinged drainage from the NG tube B. The NG tube is connected to low pressure suction C. The client is lying in a semi-Fowler position D. The nurse assesses for abdominal distention and finds it distended
A. There is clear, colorless, bile-tinged drainage from the NG tube A Whipple procedure is the removal of the head of the pancreas, the distal portion of the common bile duct, the duodenum, and part of the stomach. It's a surgical tx option for pancreatic cancer. An NG tube may be inserted to prevent stress on the anastomosis sites. Drainage should be serosanguineous. Clear, colorless, bile-tinged drainage can indicate a problem with the anastomosis sites. The nurse should contact the provider after making this assessment. All of the other assessments listed are appropriate/correct meaning they don't require the nurse to intervene and fix something that's wrong. Low pressure suction of 20-80 mm Hg is often used because excess negative pressure in the stomach or bowels can pull the mucosa into the lumen of the tube and cause traumatic ulcers. If drainage is not adequate, obtain a prescription to irrigate, using minimal pressure. It's good to maintain the client in semi-Fowler position after a Whipple because it facilitates lung expansion and reduces stress on the anastomosis and suture line. Assessing for abdominal distention is good because this is one of numerous possible signs that the NG tube is obstructed. Other signs of NGT obstruction or that the suctioning apparatus is malfunctioning includes abdominal distention, vomiting, and nausea. If drainage is inadequate, obtain a rx to irrigate, using minimal pressure. Forceful irrigations and repositioning of the NGT may disrupt the suture line.
The nurse provides care for a 64 y/o client in the outpatient clinic. Nurse's notes: 64 y/o client presents to the clinic with reports of increasing fatigue and unintentional weight loss of "about 15 lbs in the last month or so." Health maintenance includes annual physicals, prostate exam, PSA, EKG, chest x-ray, as required by his company. Last colonoscopy was 12 years ago and according to the client, was "normal." Currently works as a long haul trucker. Occasional alcohol use. Has smoked cigars off and on for 20 years to "keep me awake at night, when I'm driving." Admits diet is "not very good" when on the road; lots of fast food and very few fruits and vegetables. Client admits to having noticed blood in the toilet after bowel movements "for a few weeks." VS: Oral temperature: 98.8 F (37.8 C) HR: 82 RR: 16 BP: 168/98 Oximetry: 98% on room air Height: 5'9" (1.75 m) Weight: 219 lbs (99.3 kg) The client had a colonoscopy with polyp removal and the pathology showed the polyps were adenomas with dysplasia, likely cancerous. The client was referred to a surgeon and a hemicolectomy is scheduled for one week. For each topic below, identify whether it should or should not be included when teaching this client about post-operative care. - post-operative activity - progression of diet - referral to oncology - temporary changes in bowel habits - post-operative pain control
All of the topics listed should be included in patient education on post-op care: - post-operative activity - progression of diet - referral to oncology - temporary changes in bowel habits - post-operative pain control A hemicolectomy is a procedure to remove the part of the colon that has cancer in it.
A client is scheduled for a total laryngectomy. The client tells the nurse, "I am worried about my operation. I just can't help it." Which response by the nurse is best? A. "Have you discussed your worries with your health care provider?" B. "What is your biggest worry at the moment?" C. "You have a really fine health care provider so there seems to be little need to worry." D. "Everyone worries about surgery, especially when it is a first time experience."
B. "What is your biggest worry at the moment?" It is within the scope of practice of the nurse to discuss patient worries, so it's wrong to redirect that type of conversation to the provider. The third answer is kind of dismissive, non-therapeutic kind of communication. It's false reassurance. The fourth answer is an example of an "automatic response," or a stereotypical response that communicates to the client that you are not taking the client's concern seriously or responding thoughtfully. Asking what the patient's biggest worry is at the moment shows that the nurse is trying to understand their individual concerns, instead of giving a general response. Additionally, this nurse shows that they're seeking additional information to determine what the client needs, such as information and clarification, to feel prepared for surgery.
The nurse leads adult women in a wellness class. The nurse instructs the class about risk factors for developing breast cancer. The nurse intervenes if one of the women makes which statement? A. "Women over the age of 40 have a greater chance of developing breast cancer." B. "Women with breast implants have a higher risk of developing breast cancer." C. "Women who have a mother or sister with breast cancer are at a higher risk of developing breast cancer." D. "Women who have never had children have a higher risk of developing breast cancer."
B. "Women with breast implants have a higher risk of developing breast cancer." Neither saline nor silicone breast implants have been found to increase a woman's risk of developing breast cancer. If one of the attendees of the wellness class says they do, they'd be wrong and the nurse should correct them. If the attendees were to say any of the other statements, they'd be correct. The older a woman is, the more likely she is to develop breast cancer. Rates begin to increase after age 40 and are highest in women over age 70. The median age of dx of breast cancer for women in the US is 62 (but this varies by race and ethnicity). Go back to your genetics knowledge - when first degree relatives are affected by a condition, you're highly likely to be affected by it too. Women with a first degree relative (mother, sister, daughter) with breast cancer are about twice the risk of getting it compared to women without the family hx of it. The more first degree relatives affected, the higher the risk (2-4x the risk of women w/o family hx). Women who never give birth have a slightly higher risk of breast cancer compared to women who've had more than one birth. However, women over 35 who give birth only once have a slightly higher lifetime risk of breast cancer compared to women who never give birth.
A client diagnosed with terminal cancer says to the nurse, "I'm dying because the health care providers didn't operate soon enough. How could they do this to me?" The nurse recognizes that the client is probably in which stage of the grieving process? A. Denial B. Anger C. Depression D. Guilt
B. Anger The patient is not in denial. They understand that they are dying, and that their illness is terminal. This response is not indicative of depression. That would more likely be manifested by statements of despair and feeling overwhelmed, or in actions indicating withdrawal or sadness. In the guilt phase of grief, clients are more likely to blame themselves for real or fantasized omissions or neglect that may have caused or contributed to the situation. This client's statement shows displaced anger on the medical staff. Anger is the second stage of grief, but may occur intermittently throughout the grieving process. Grief is a fluid situation with movement between stages, and less time is spent in stages previously experienced by the client.
The nurse knows which finding is the most life-threatening adverse effect of chemotherapy? A. Alopecia B. Bone marrow suppression C. Vomiting D. Mucositis
B. Bone marrow suppression Chemotherapy has many bad side fx but this question is asking you which can be fatal to a person. Bone marrow suppression can result in decreased leukocytes, erythrocytes, and platelets. That puts the client at high risk of bleeding and infection. Alopecia is hair loss and can make a significant effect on a person d/t impact on body image, but it doesn't pose a life-threatening risk to the client. N/v are common adverse fx of chemo and can cause f and e imbalances or pH imbalances if not txed properly, but are not fatal to chemo patients either. Patients should be given antiemetics on a schedule to prevent and control this, and should be encouraged to drink clear liquids, served cold and sipped slowly to prevent dehydration. Mucositis consists of sores in the mucous membranes of the GI tract. Mouth sores may interfere with the client's ability to eat and should be assessed and txed, but mucositis again isn't life-threatening.
Two weeks after beginning chemotherapy treatments, a client's WBC count is 3000/mm^3 (3 x 10^9/L). Which intervention is most important for the nurse to implement? A. Encourage ambulation in the hallway B. Demonstrate meticulous hand washing C. Provide a high calorie diet D. Administer prescribed antiemetics
B. Demonstrate meticulous hand washing The patient's WBC is low, indicating they're immunocompromised and more susceptible to infection. This can happen after chemo bc of bone marrow suppression. Diligent handwashing practices will help prevent infection. You can also take other neutropenic precautions like giving them a private room and monitoring for any s/s of infection. If the patient's WBCs are low after chemo d/t bone marrow suppression, they likely also have anemia d/t decreased erythrocyte production as well. Having anemia means they'll likely also be fatigued, so encouraging more activity might not be the best idea until you figure out how to properly balance rest with activity for the patient. Ambulation has no relationship to WBCs in the body. Because chemo can cause n/v, which can lead to weight loss, chemo patients should be encouraged to eat frequent, high calorie meals. So providing a high calorie diet is an appropriate intervention for this demographic of patients, but will not address their WBC levels. Administering prescribed antiemetics is also an appropriate intervention for addressing n/v, but again has no effect on WBCs and isn't the priority for someone who's immunocompromised.
Which nursing goal does the nurse recognize as the highest priority for a client receiving narcotic analgesics for pain from metastatic lung cancer? A. Improved sleep B. Effective airway and respirations C. Reduction in perceived pain D. Effective coping
B. Effective airway and respirations Improved sleep is a consequence of good pain control, but this isn't your main concern in assessing a patient with this condition on narcotic pain meds. You should most definitely want to reduce the patient's perceived pain, but cancer pain is very intense and severe. Sometimes pharmacological methods aren't enough to provide relief, so other holistic methods have to be explored and used in combination with them. Coping is another good priority for the nurse to have, but is not one that's related to pain meds. It is essential to monitor respirations in clients with cancer related pain. Clients experiencing cancer pain may require escalating doses of narcotic pain medication to achieve pain control. Respiratory depression is an adverse effect of narcotic analgesics and can lead to coma or respiratory arrest. Adjuvant analgesics, such as NSAIDs, should be added to an opioid to enhance pain relief provided by the opioid, and allow the reduction of the opioid dose to reduce adverse effects.
A client has an internal radium implant for uterine cancer. Which client statement indicates an understanding of safety concerns? A. "I want a nurse to give me a bath in bed and wash my hair this morning." B. "I would like someone from my family to sit by my bed and hold my hand." C. "My spouse is planning to visit for a few minutes but is going to talk with me from the doorway." D. "I hope my family will bring the grand baby by for a short visit. That would cheer me up."
C. "My spouse is planning to visit for a few minutes but is going to talk with me from the doorway." This above statement indicates that the client understands that other individuals should maintain a distance of 6 feet from the source of radiation as much as possible. This also means that the patient needs to primarily care for themselves. The nurse also needs to limit radiation exposure as much as possible, so that means any care should be limited to 10-30 minutes at a time. It's wrong that the family or any visitors can stand right by the bed and hold the client's hand. They might feel isolated while they have the implant in, but that doesn't mean you can disregard the safety issue with radiation. Children younger than 18 years old and pregnant females should not be exposed to an individual with an internal radium implant.
A client scheduled for a bone marrow biopsy tomorrow morning appears anxious and wants to know what is going to happen. Which is the best response by the nurse? A. "A needle will numb the area, then the health care provider will put a needle into the bone in your shin and draw out the bone marrow." B. "You will be given a local anesthetic in the skin and bone, so after the initial needle you shouldn't feel anything." C. "You may feel pressure when they take the marrow out, but it only lasts a few seconds." D. "You will be asleep for the procedure and won't feel anything except a slight discomfort after you wake up."
C. "You may feel pressure when they take the marrow out, but it only lasts a few seconds." The first answer gives procedural information, but not information about what the client should be expected to feel. Plus, bone marrow biopsies are taken from the iliac crest or sternum, not shins. The second answer gives misinformation. Although the skin and bone are treated with local anesthetic, there will be a very brief and uncomfortable sensation. The client should be made aware of this so that they can expect the sensation and know that it's normal. General anesthesia puts patients to sleep. Clients are not typically given general anesthesia for a bone marrow biopsy. Despite local anesthesia to the skin and bone, there will be a very brief uncomfortable sensation, so telling the patient this lets them prepare for it and know it's normal. Nursing responsibilities after the procedure include cleansing the site with alcohol to remove povidone iodine, applying pressure with sterile gauze pad for several minutes to control bleeding, and applying sterile pressure dressing.
A client experiences numbness and decreased sensations in both lower extremities during the course of treatment with vinblastine. The nurse instructs the client to take which action? A. Soak both legs in hot water four times each day. B. Increase walking to three times a week for 30 min. C. Ambulate carefully with broad-based gait. D. Elevate legs while sitting.
C. Ambulate carefully with broad-based gait. Vinblastine is a vinca alkaloid chemotherapeutic medication administered via IV. Adverse effects include n/v, stomatitis, and peripheral neuropathy (numbness and decreased sensation). Peripheral neuropathy is a potential adverse effect from vinblastine resulting in a loss of reflexes and peripheral neuritis. The client is at increased risk of stumbling and falls and should be instructed to use a broad-based gait when ambulating, perform exercises to maintain and improve balance, and ensure pathways are clear when moving about. Do not soak legs in hot water when you have numbness or decreased sensation in them because you risk burning yourself accidentally. Increasing activity doesn't help with numbness and sensation, though activity is still good for cardiovascular health but also still balance activity and rest. Elevating legs does nothing for peripheral neuropathy. It's useful in other circumstances like dependent edema because it'll help improve venous return though.
The nurse leads a smoking cessation class. Which instruction does the nurse give first? A. Remove ashtrays and lighters from view. B. Go to places that tempt the client to smoke to test the resolve. C. Make a list of all of the reasons you would like to quit smoking. D. Discuss medications that can curb cravings.
C. Make a list of all of the reasons you would like to quit smoking. To be successful, the client has to have a willingness to learn and change behavior in oneself. If they're not personally motivated to change, instructing the client about how to change will be unsuccessful. Identifying reasons the client would like to quit smoking can serve as a motivator to change behavior and increase the willingness to learn. Removing ashtrays and lighters is a way of removing visual stimulation to smoke, but this is a type of measure that can better be taught later in the class. Changing one's environment is important, but motivation to stop smoking must come from within oneself and has to be considered top priority when trying to break this habit and eliciting change. Going to places that tempt the client to smoke in order to test their resolve is inappropriate for a smoking cessation class. Instead, they should be encouraged to avoid places like that and develop new routines during times that previously would have been an excuse to smoke. Discussing meds that can help you quit smoking is an appropriate lesson for this kind of class, but is one that should come later. Meds can help curb cravings and may also make smoking less satisfying. Other drugs can ease withdrawal sx, such as depression or problems with concentration. Also, using nicotine replacement therapy can curb urges. Nicotine gum, lozenges, and patches may improve the client's change of success.
The nurse provides care for a client receiving chemotherapy. The client's WBC and hct are very low due to immunosuppression. The nurse intervenes in the client's care if which action is observed? A. The client's family members wear masks when visiting the client. B. The client is placed in a private room. C. The UAP obtains the client's BP with the UAP's personal stethoscope. D. The client's spouse removes the fresh flowers and fruit baskets from the room.
C. The UAP obtains the client's BP with the UAP's personal stethoscope. Patients with low WBCs should be placed on neutropenic precautions, and this question is asking you to differentiate between what are and what are not neutropenic precautions. Using personal equipment like one's stethoscope is wrong because you could carry germs that cause an infection in the patient by using it. Instead, staff should use dedicated patient care equipment specific to them or disposable equipment. The other options qualify as appropriate neutropenic precautions. Having visitors use mask and placing the patient in a private room minimizes opportunities to transmit infection. Fresh fruits and flowers may contain harmful bacteria which can be dangerous for the client.
A client diagnosed with acute myelogenous leukemia (AML) begins menstruating. Which action does the nurse take first? A. Instructs the client to report any increased dizziness and weakness B. Contacts the health care provider C. Weighs the client's pads and tampons before and after use D. Asks the client if there is a past history of heavy periods
C. Weighs the client's pads and tampons before and after use The client with AML may bleed excessively due to thrombocytopenia. It is important for the nurse to determine the amount of blood loss and report to the provider. It is prematurely to automatically contact the health care provider. Instead, the nurse should first assess the patient's status so that more complete information can be communicated. Instructing the patient to talk to them about any increased dizziness and weakness is an appropriate action, but not the first priority. History of heavy flow with periods doesn't impact immediate treatment. Clients with AML may bleed excessively due to thrombocytopenia. It is important for the nurse to determine the amount of blood loss and report to the health care provider. This is done by weighing the client's pads and tampons before and after use.
On the evening before a scheduled lung biopsy, a client says to the nurse, "Do you think I have cancer?" Which response by the nurse is most appropriate? A. "It is not for me to say. You'll know after tomorrow." B. "You know that you have been taking a chance smoking cigarettes all these years." C. "Several tests will have to be done to confirm that diagnosis." D. "You sound worried about what they might find tomorrow."
D. "You sound worried about what they might find tomorrow." This response by the nurse utilizes a therapeutic technique called paraphrasing - restating another's message using one's own words. It lets the client know that the nurse is actively involved in the search for understanding. The other responses are non-therapeutic or unprofessional. The first is a closed response that doesn't encourage dialog. The client may be trying to communicate fear or anxiety and the nurse's response blocks further discussion. Disapproval or imposing the nurse's own attitudes, values, beliefs, and moral standards on others is inappropriate while acting in a professional role.
The nurse performs health screenings on a group of clients. The nurse identifies which individual is at greatest risk for developing skin cancer? A. An adolescent client with dark skin who works as a lifeguard at the local pool B. An adult client with light skin who works as a cashier at the local store C. A middle age adult client with dark skin who swims daily at a health club D. An older adult client with light skin who worked as a roofer for 40 years
D. An older adult client with light skin who worked as a roofer for 40 years Risk factors for developing skin cancer include clients who have a light skin complexion, people over the age of 60, and individuals who have had overexposure to sunlight. Other risk factors include presence of numerous moles and certain types of moles, a family history of skin cancer, skin that burns or reddens easily in the sun, blue or green eyes, and blond or red hair color. You need to use this information to assess each of the patients provided to determine their relative risk. Younger clients should be educated to use sunscreen and limit exposure to the sun as skin cancer can still develop with repeated exposure. This older adult client meets the risk factor criteria for age, exposure/occupation (roofer), and light skin color.
After 2 weeks of chemotherapy treatments, a client's white blood cell count is 2000/mm^3. The nurse knows this finding is most likely due to which factor? A. Infection B. Bone marrow depression C. Weight loss D. Polycythemia
D. Polycythemia Normal WBC count is 4500-11,000/mm^3. Decreased white blood cell counts cause infection, which then prompt a normal immune system to put out a ton more WBCs than normal. Weight loss is unrelated to WBC count. It should be noted that chemo side effects include nausea and vomiting, which can lead to weight loss. Polycythemia is when you have hematocrit that's persistently 55%. Treatment is repeated phlebotomy. Polycythemia isn't seen with chemo. Chemotherapy causes bone marrow depression. Bone marrow produces RBCs, WBCs, and platelets, so when the function is depressed, a consequence is that WBC production goes down.
A client diagnosed with terminal pancreatic cancer is admitted to the hospice facility. The client's partner has been providing all of the client's daily care as well as caring for two young children. Which admitting information for this couple is appropriate for the nurse to review? A. Limit visitation by the children while the client is in hospice care B. Encourage the client's partner to avoid discussing the client's illness or possible death in front of the children C. Instruct the client's partner to maintain a positive atmosphere and avoid discussing concerns with the client D. Provide privacy when any news of changes in the client's condition are communicated to the family
D. Provide privacy when any news of changes in the client's condition are communicated to the family It's not right to limit visitation. Children should be encouraged to visit the parent while in hospice if they want to. Still, they should be prepared for any changes in the parent's condition or appearance and also for any medical equipment or procedures they may witness when they visit. Children should have time to decompress and ask questions after visiting if needed. Children shouldn't be provided with false reassurances nor given detailed information they can't process, so it's not right to make the partner avoid discussing the client's illness or possible death in front of the children. The third answer enables denial of reality, which you don't want to do. It is better to encourage family members to discuss normal family activities and feelings, including concerns the client may have. Fostering a calm, peaceful atmosphere is important, but it may not be possible to avoid any negative or emotional interactions. The nurse should communicate and be transparent about any changes in condition or the impending death to the family in a private area. The nurse should remain with the family members, provide support, and facilitate questions or expressions of grief that may occur.
The nurse provides care for the client diagnosed with lung cancer and receiving chemotherapy. The nurse notes the client's platelet count is 60,000/mm^3. Which action by the nurse is most appropriate? A. The nurse administers an IM injection with a 21-gauge needle. B. The nurse obtains the client's temperature rectally. C. The nurse observes the IV site every 8 hours for bleeding. D. The nurse checks the bristles on the client's toothbrush.
D. The nurse checks the bristles on the client's toothbrush. These plt levels are way below normal, making the client a high bleeding risk (no plts, no clotting). Using a soft-bristled toothbrush is one example of a bleeding precaution. Also related is avoiding flossing and hard foods to decrease risk of bleeding from the gums. You should avoid injections whenever possible for patients on bleeding precautions. Having low plts isn't corrected via injection. Even if an IM injection was necessary given the patient's medication regimen, the smallest gauge needle should be used to minimize trauma, and firm pressure should be applied to the stick site for 10 min. Don't take rectal temperatures or administer enemas to avoid trauma to and bleeding of the rectal tissue. Because the patient is such a high bleeding risk, observing the IV site every 8 hours for bleeding isn't frequent enough. Instead, it should be assessed every 2 hours.
A client has a family history of pancreatic cancer and wants to know how to recognize the disease in the early stages. The nurse instructs the client about which signs of pancreatic cancer? A. Intolerance to fatty foods and frequent belching B. Cramp-like abdominal pain and nausea C. Polyphasic and bloody diarrhea D. Weight loss and jaundice
D. Weight loss and jaundice Intolerance to fatty foods, which progresses to all foods, and belching are seen in the later stages of pancreatitis. Pain associated with pancreatic cancer is seen with the epigastric region, which then radiates to the back. Nausea isn't usually an early sign of pancreatic cancer. Polyphagia (excessive hunger) is not associated with pancreatic cancer either. Most patients experience anorexia during the early stages of pancreatic cancer. Bloody diarrhea isn't seen here either, but regular diarrhea and constipation are possible symptoms. Weight loss and jaundice are characteristic signs of early pancreatic cancer. Other signs may include dark urine, light-colored stool, back pain, fatigue, weakness, and digestive problems.
