Deck 18: Cancer

Question 1

The nurse is caring for a client who is receiving a vesicant chemotherapeutic agent intravenously. Which of the following actions is most important?

A)Infuse the medication over a short period of time.
B)Stop the infusion if swelling is observed at the site.
C)Administer the chemotherapy through small-bore catheter.
D)Hold the medication unless a central venous line is available.

Answer 1

Stop the infusion if swelling is observed at the site.

Question 2

The nurse is caring for a client with Hodgkin's lymphoma who is undergoing external radiation therapy and tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which of the following interventions should the nurse implement?

A)Minimize activity until the treatment is completed.
B)Exercise vigorously when fatigue is not as noticeable.
C)Establish a time to take a short walk almost every day.
D)Consult with a psychiatrist for treatment of depression.

Answer 2

Establish a time to take a short walk almost every day.

Question 3

The nurse is caring for a client undergoing external radiation and has developed a dry desquamation of the skin in the treatment area. Which of the following client statements indicates that the nurse's teaching about management of the skin reaction hasbeeneffective?

A)"I can buy some aloe gel to use on the area."
B)"I will expose the treatment area to a sun lamp daily."
C)"I can use ice packs to relieve itching in the treatment area."
D)"I will scrub the area with warm water to remove the scales."

Answer 3

"I can buy some aloe gel to use on the area."

Question 4

The nurse is caring for a client who is receiving intravesical bladder chemotherapy. Which of the following adverse effects should the nurse monitor for in this client?

A)Nausea
B)Alopecia
C)Mucositis
D)Hematuria

Question 5

Which of the following information obtained by the nurse about a client with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for client teaching?

A)The client swims in a pool 5 days a week.
B)The client has a history of dental caries.
C)The client eats frequently during the day.

Question 6

The nurse in the outpatient clinic is caring for a client who smokes heavily. To reduce the client's risk of dying from lung cancer, which of the following actions will be best for the nurse to take?

A)Educate the client about the seven warning signs of cancer.
B)Plan to monitor the client's carcinoembryonic antigen (CEA) level.
C)Discuss the risks associated with cigarettes during every client encounter.
D)Teach the client about the use of annual chest x-rays for lung cancer screening.

Question 7

During a routine health examination, a client tells the nurse about a family history of colon cancer. Which of the following actions should the nurse take next?

A)Educate the client about the need for a colonoscopy at age 50.
B)Teach the client how to do home testing for fecal occult blood.
C)Obtain more information from the client about the family history.
D)Schedule a sigmoidoscopy to provide baseline data about the client.

Question 8

The nurse is caring for a client who is a single mother of four school-age children and is hospitalized with metastatic ovarian cancer. The nurse finds the client crying, and she tells the nurse that she does not know what will happen to her children whenshedies. Which of the following is the most appropriate response?

A)"Why don't we talk about the options you have for the care of your children?"
B)"Perhaps the children's father will take care of them when you aren't able to."
C)"For now you need to concentrate on getting well, not worry about your children."
D)"Many clients with cancer live for a long time, so there is time to plan for your children."

Question 9

Which of the following nursing actions will be most effective in improving oral intake for a client with the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers?

A)Offer the client frequent small snacks between meals.
B)Assist the client to choose favourite foods from the menu.
C)Provide education about the importance of nutritional intake.
D)Apply the ordered anaesthetic gel to oral lesions before meals.

Question 10

A client receiving head and neck radiation has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which of the following actions should the nurse teach the client to complete?

A)Remove food debris from the teeth and oral mucosa with a stiff toothbrush.
B)Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth.
C)Gargle and rinse the mouth several times a day with an antiseptic mouthwash.
D)Rinse the mouth before and after each meal and at bedtime with a saline solution.

Question 11

Which statement by a client who is scheduled for a needle biopsy of the prostate indicates that the nurse's teaching about the purpose of the biopsy has been effective?

A)"The biopsy will remove the cancer in my prostate gland."
B)"The biopsy will determine how much longer I have to live."
C)"The biopsy will help decide the treatment for my enlarged prostate."
D)"The biopsy will indicate whether the cancer has spread to other organs."

Question 12

Aclient with a large stomach tumour that is attached to the liver is scheduled to have a debulking procedure. When teaching the client, which of the following is the expected outcome of this surgery?

A)Relief of pain by cutting sensory nerves in the stomach
B)Control of the tumour growth by removal of malignant tissue
C)Decrease in tumour size to improve the effects of other therapy
D)Promotion of better nutrition by relieving the pressure in the stomach

Question 13

A client with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which of the following interventions should the nurse implement?

A)Teach about the importance of nutrition during treatment.
B)Have the client eat large meals when nausea is not present.
C)Offer dry crackers and carbonated fluids during chemotherapy.
D)Administer prescribed antiemetics 1 hour before the treatments.

Question 14

A chemotherapeutic agent known to cause alopecia is prescribed for a client. Which of the following actions should the nurse plan to implement to help maintain the client's

A)Suggest that the client limit social contacts until regrowth of the hair occurs.
B)Encourage the client to purchase a wig or hat and wear it once hair loss begins.
C)Have the client wash the hair gently with a mild shampoo to minimize hair loss.
D)Inform the client that the hair will grow back once the chemotherapy is complete.

Question 15

The nurse is teaching a client who is postmenopausal and has stage III breast cancer about the expected outcomes of her cancer treatment. Which client statement indicates that the teaching has been effective?

A)"After cancer has not recurred for 5 years, it is considered cured."
B)"The cancer will be cured if the entire tumour is surgically removed."
C)"Cancer is never considered cured, but the tumour can be controlled with surgery, chemotherapy, and radiation."
D)"I will need to have follow-up examinations for many years after I have treatment before I can be considered cured."

Question 16

The nurse is caring for a client with ovarian cancer who is distressed because her husband rarely visits and tells the nurse, "He just doesn't care." The husband indicates to the nurse that "I never know what to say to help her." Which of the followingnursing diagnoses is most appropriate?

A)Disabled family coping related to chronically unexpressed feelings by support person
B)Impaired home maintenance related to insufficient support system
C)Risk for caregiver role strain as evidenced by increase in care needs
D)Dysfunctional family processes related to insufficient problem-solving skills

Question 17

After the nurse has finished teaching a client who is scheduled to receive external beam radiation for abdominal cancer about appropriate diet, which dietary selection by the client indicates that the teaching has been effective?

A)Fresh fruit salad
B)Roasted chicken
C)Whole wheat toast
D)Cream of potato soup

Question 18

External-beam radiation is planned for a client with endometrial cancer. The nurse teaches the client which of the following important measures to help prevent complications from the effects of the radiation?

A)Test all stools for the presence of blood.
B)Maintain a high-residue, high-fibre diet.
C)Clean the perianal area carefully after every bowel movement.
D)Inspect the mouth and throat daily for the appearance of thrush.

Question 19

The nurse is preparing a client for a biopsy of a lump in the right breast and the client asks the nurse about the difference between a benign tumour and a malignant tumour. Which of the following responses by the nurse is correct?

A)"Benign tumours do not cause damage to other tissues."
B)"Benign tumours are likely to recur in the same location."
C)"Malignant tumours may spread to other tissues or organs."
D)"Malignant cells reproduce more rapidly than normal cells."

Question 20

When reviewing the chart for a client with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. Which of the following statements is accurate related to this staging?

A)The cancer is localized to the cervix.
B)The cancer cells are well differentiated.
C)Further testing is needed to determine the spread of the cancer.
D)It is difficult to determine the original site of the cervical cancer.

Question 21

When assessing the need for psychological support after the client has diagnosed with stage I cancer of the colon, which of the following questions by the nurse will provide the most information?

A)"How long ago were you diagnosed with this cancer?"
B)"Do you have any concerns about body image changes?"
C)"Can you tell me what has been helpful to you in the past when coping with stressful events?"
D)"Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?"

Question 22

The nurse at the clinic is interviewing an older-adult client who is 160 cm tall and weighs 57 kg. The client has not seen a health care provider for 20 years. She walks 11 km most days and has a glass of wine two or three times a week. Which topics willthe nurse plan to include in client teaching about cancer screening and decreasing cancer risk? (Select all that apply.)

A)Pap testing
B)Tobacco use
C)Sunscreen use
D)Mammography
E)Colorectal screening

Question 23

The home health nurse is caring for a client who has been receiving interferon therapy for treatment of cancer. Which statement by the client may indicate a need for a change in treatment?

A)"I have frequent muscle aches and pains."
B)"I rarely have the energy to get out of bed."
C)"I experience chills after I inject the interferon."
D)"I take acetaminophen every 4 hours."

Question 24

The nurse teaches a client with cancer of the liver about high-protein, high-calorie diet choices. Which of the following snack choices by the client indicates that the teaching has been effective?

A)Orange sherbet
B)Fresh fruit salad
C)Strawberry yogourt
D)Cream cheese bagel

Question 25

The nurse obtains information about a hospitalized client who is receiving chemotherapy for cancer of the colon. Which of the following information about the client is most indicative of a need for a change in therapy?

A)Poor oral intake
B)Increase in carcinoembryonic antigen
C)Frequent loose stools
D)Complaints of nausea

Question 26

The nurse is caring for a client with tumour lysis syndrome (TLS) who is taking allopurinol. Which of the following laboratory values should the nurse monitor to determine the effectiveness of the medication?

A)Uric acid level
B)Serum potassium
C)Serum phosphate
D)Blood urea nitrogen

Question 27

After receiving change-of-shift report, which of the following clients should the nurse assess first?

A)35-year-old who has wet desquamation associated with abdominal radiation
B)42-year-old who is sobbing after receiving a new diagnosis of ovarian cancer
C)24-year-old who is receiving neck radiation and has blood oozing from the neck
D)56-year-old who has a new pericardial friction rub after receiving chest radiation

Question 28

The nurse is caring for a client with cancer who has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which of the following nursing actions is most appropriate?

A)Add strained baby meats to foods such as casseroles.
B)Teach the client about foods that are high in nutrition.
C)Avoid giving the client foods that are strongly disliked.
D)Put extra spice in the foods that are served to the client.

Question 29

Which of the following findings in a client who is receiving interleukin-2 indicates a need for rapid action by the nurse?

A)Generalized muscle aches
B)Complaints of nausea and anorexia
C)Oral temperature of 38.1°C (100.6°F)
D)Crackles heard at the lower scapular border

Question 30

The nurse is caring for a client with metastatic renal cell carcinoma who is receiving interleukin-2 (IL-2) as an adjuvant therapy. Which of the following mechanisms of action should the nurse teach the client about this therapy?

A)It enhances immunological response to tumour cells.
B)It stimulates malignant cells in the resting phase to enter mitosis.
C)It prevents the bone marrow depression caused by chemotherapy.
D)It protects normal cells from the harmful effects of chemotherapy.

Question 31

The nurse is teaching a client who has a new diagnosis of acute leukemia about the complications associated with chemotherapy. The client is restless and is looking away, never making eye contact. After the teaching, the client asks the nurse to repeatallofthe information. Based on this assessment, which of the following nursing diagnoses is most likely for this client?

A)Ineffective denial related to ineffective coping strategies (leukemia diagnosis)
B)Acute confusion related to pain (infiltration of leukemia cells into the central nervous system)
C)Anxiety related to threat of death (leukemia diagnosis)
D)Deficient knowledge (of chemotherapy) related to insufficient interest in learning

Question 32

The nurse is caring for a client who is undergoing bone marrow transplantation. Which of the following information should the nurse include in the client's teaching plan?

A)Transplant of the donated cells is painful because of the nerves in the tissue lining the bone.
B)Donor bone marrow cells are transplanted through an incision into the sternum or hip bone.
C)The transplant procedure takes place in a sterile operating room to minimize the risk for infection.
D)Hospitalization will be required 2-4 weeks after transplantation.

Question 33

Which of the following information noted by the nurse reviewing the laboratory results of a client who is receiving chemotherapy is most important to report to the health care provider?

Question 34

Use of dental floss is contraindicated in the client with which of the following assessment findings?

A)Halitosis
B)A decreased platelet count
C)An increased white blood cell count
D)Xerostomia

Question 35

When caring for a client with a temporary radioactive cervical implant, which action by the student nurse indicates that the unit nurse should intervene?

A)The student flushes the toilet once after emptying the client's bedpan.
B)The student stands by the client's bed for 30 minutes talking with the client.
C)The student places the client's bedding in the laundry container in the hallway.
D)The student gives the client an alcohol-containing mouthwash to use for oral care.

Question 36

A client who has severe pain associated with terminal liver cancer is being cared for at home by family members. Which of the following findings indicates that teaching regarding pain management has been effective?

A)The client agrees to take the medications by the IV route in order to improve analgesic effectiveness.
B)The client uses the ordered opioid pain medication whenever the pain is greater than 5 (0-10 scale).
C)The client takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
D)The client states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.

Question 37

The nurse is caring for a client who is receiving chemotherapy for leukemia. Which of the following observations require intervention by the nurse?

A)The client ambulates several times a day in the room.
B)The client's temperature is 38.2°C (100.8°F).
C)The client cleans with a warm washcloth after having a stool.
D)The client uses soap and shampoo to shower every other day.