Cancer Exam

Question 1

Which question asked by the nurse will give the most information about the patient’s metastatic bone cancer pain?

a. “How long have you had this pain?”
b. “How would you describe your pain?”
c. “How often do you take pain medication?”
d. “How much medication do you take for the pain?”

Answer 1

ANS: B
Because pain is a multidimensional experience, asking a question that addresses the patient’s experience with the pain will elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning “How would you describe your pain?” is the best initial question.

Question 2

A patient who has had good control for chronic pain using a fentanyl (Duragesic) patch reports rapid onset pain at a level 9 (0 to 10 scale) and requests “something for pain that will work quickly.” How will the nurse document the type of pain reported by this patient?

a. Somatic pain c. Neuropathic pain
b. Referred pain d. Breakthrough pain

Answer 2

ANS: D
Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system. Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.

Question 3

The nurse teaches a student nurse about the action of ibuprofen. Which statement, if made by the student, indicates that teaching was effective?

a. “The drug decreases pain impulses in the spinal cord.”
b. “The drug decreases sensitivity of the brain to painful stimuli.”
c. “The drug decreases production of pain-sensitizing chemicals.”
d. “The drug decreases the modulating effect of descending nerves.”

Answer 3

ANS: C
Nonsteroidal antiinflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by NSAIDs.

Question 4

A nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil) in addition to long-acting morphine (MS Contin). Which statement, if made by the patient, indicates to the nurse that the patient is receiving adequate pain control?

a. “I’m not anxious during the day.”
b. “Every night I get 8 hours of sleep.”
c. “I can accomplish activities without much discomfort.”
d. “I feel less depressed since I’ve been taking the Tofranil.”

Answer 4

ANS: C
Imipramine is being used in this patient to manage chronic pain and improve functional ability. Although the medication is also prescribed for patients with depression, insomnia, and anxiety, the evaluation for this patient is based on improved pain control and activity level.

Question 5

A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis. The patient’s spouse asks the nurse how these techniques work. Which response by the nurse is accurate?

a. “The strategies work by affecting the perception of pain.”
b. “These techniques block the pain pathways of the nerves.”
c. “These strategies prevent transmission of stimuli from the back to the brain.”
d. “The therapies slow the release of chemicals in the spinal cord that cause pain.”

Answer 5

ANS: A
Cognitive therapies affect the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.

Question 6

A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which action by the nurse is appropriate for treating this change in assessment?

a. Suggest amitriptyline 10 mg orally.
b. Administer lorazepam (Ativan) 1 mg orally.
c. Give ibuprofen (Motrin) 400 to 800 mg orally.
d. Offer immediate-release morphine 30 mg orally.

Answer 6

ANS: D
The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. Lorazepam and amitriptyline may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of antianxiety agents for pain control is inappropriate because this patient’s anxiety is caused by the pain.

Question 7

A patient with chronic neck pain is seen in the pain clinic for follow-up. To evaluate whether the pain management is effective, which question is best for the nurse to ask?

a. “Has there been a change in pain location?”
b. “Can you describe the quality of your pain?”
c. “How would you rate your pain on a 0 to 10 scale?”
d. “Does the pain keep you from activities that you enjoy?”

Answer 7

ANS: D
The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions are also appropriate to ask, but information about patient function is more useful in evaluating effectiveness.

Question 8

A patient with a deep partial thickness burn has been receiving hydromorphone through patient-controlled analgesia (PCA) for 1 week. The nurse caring for the patient during the previous shift reports that the patient wakes up frequently during the night complaining of pain. What action by the nurse is appropriate?

a. Administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.
b. Consult with the health care provider about using a different treatment protocol to control the patient’s pain.
c. Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
d. Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.

Answer 8

ANS: B
PCAs are best for controlling acute pain. This patient’s history indicates a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.

Question 9

The nurse assesses that a patient receiving epidural morphine has not voided for more than 10 hours. What action should the nurse take initially?

a. Place an indwelling urinary catheter.
b. Monitor for signs of narcotic overdose.
c. Ask if the patient feels the need to void.
d. Encourage the patient to drink more fluids.

Answer 9

ANS: C
Urinary retention is a common side effect of epidural opioids. Assess whether the patient feels the need to void. Because urinary retention is a possible side effect, there is no reason for concern of overdose symptoms. Placing an indwelling catheter requires an order from the health care provider. Usually an in-and-out catheter is performed to empty the bladder if the patient is unable to void because of the risk of infection with an indwelling catheter. Encouraging oral fluids may lead to bladder distention if the patient is unable to void, but might be useful if a patient who is able to void has a fluid deficit

Question 10

The nurse assesses that a home hospice patient with terminal cancer who complains of severe pain has a respiratory rate of 11 breaths/min. Which action should the nurse take?

a. Inform the patient that increasing the morphine will cause the respiratory drive to fail.
b. Tell the patient that additional morphine can be administered when the respirations are 12.
c. Titrate the prescribed morphine dose up until the patient indicates adequate pain relief.
d. Administer a nonsteroidal antiinflammatory drug (NSAID) to improve patient pain control.

Answer 10

ANS: C
The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic such as ibuprofen would not provide adequate analgesia or be absorbed quickly. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient’s respiratory rate.

Question 11

The nurse is completing the medication reconciliation form for a patient admitted with chronic cancer pain. Which medication is of most concern to the nurse?

a. Amitriptyline 50 mg at bedtime
b. Ibuprofen 800 mg 3 times daily
c. Oxycodone (OxyContin) 80 mg twice daily
d. Meperidine (Demerol) 25 mg every 4 hours

Answer 11

ANS: D
Meperidine is contraindicated for chronic pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are appropriate medications for long-term pain management.

Question 12

Which medication should the nurse administer for a patient with cancer who describes the pain as “deep, aching and at a level 8 on a 0 to 10 scale”?

a. Ketorolac tablets
b. Fentanyl (Duragesic) patch
c. Hydromorphone (Dilaudid) IV
d. Acetaminophen (Tylenol) suppository

Answer 12

ANS: C
The patient’s pain level indicates that a rapidly acting medication such as an IV opioid is needed. The other medications may also be appropriate to use but will not work as rapidly or as effectively as the IV hydromorphone.

Question 13

The nurse is caring for a patient who has diabetes and complains of chronic, burning leg pain even when taking oxycodone (OxyContin) twice daily. Which prescribed medication is the best choice for the nurse to administer as an adjuvant to decrease the patient’s pain?

a. Aspirin c. Celecoxib (Celebrex)
b. Amitriptyline d. Acetaminophen (Tylenol)

Answer 13

ANS: B
The patient’s pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain. The other medications are more effective for nociceptive pain.

Question 14

A patient who uses a fentanyl (Duragesic) patch for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take?

a. Wake the patient and administer the hydrocodone.
b. Wait until the patient wakes up and reassess the pain.
c. Suggest the use of nondrug therapies for pain relief instead of additional opioids.
d. Consult with the health care provider about changing the fentanyl (Duragesic) dose.

Answer 14

ANS: A
Because patients with chronic pain frequently use withdrawal and decreased activity as coping mechanisms for pain, sleep is not an indicator that the patient is pain free. The nurse should wake the patient and administer the hydrocodone.

Question 15

The following medications are prescribed by the health care provider for a middle-aged patient who uses long-acting morphine (MS Contin) for chronic back pain but still has ongoing pain. Which medication should the nurse question?

a. Morphine c. Pentazocine (Talwin)
b. Dexamethasone d. Celecoxib (Celebrex)

Answer 15

ANS: C
Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on mu agonist drugs such as morphine. The other medications are appropriate for the patient.

Question 16

The nurse is caring for a patient who had abdominal surgery yesterday and is receiving morphine through patient-controlled analgesia (PCA). What action by the nurse is a priority?

a. Assessing for nausea c. Checking the respiratory rate
b. Auscultating bowel sounds d. Evaluating for sacral redness

Answer 16

ANS: C
The patient’s respiratory rate is the highest priority of care while using PCA medication because of the possible respiratory depression. The other areas also require assessment but do not reflect immediately life-threatening complications.

Question 17

A patient who has fibromyalgia reports pain at level 7 (0 to 10 scale). The patient tells the nurse, “I feel depressed because I ache too much to play golf.” Which patient goal has the highest priority when the nurse is developing the treatment plan?

a. The patient will report pain at a level 2 of 10.
b. The patient will be able to play a round of golf.
c. The patient will exhibit fewer signs of depression.
d. The patient will say that the aching has decreased.

Answer 17

ANS: B
For chronic pain, patients are encouraged to set functional goals such as being able to perform daily activities and hobbies. The patient has identified playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse should also assess for depression, but the patient has identified the depression as being due to the inability to play golf, so the goal of being able to play golf is the most appropriate.

Question 18

A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic arthritic joint pain after a traumatic injury complains of nausea and abdominal fullness. Which action should the nurse take initially?

a. Administer the ordered antiemetic medication.
b. Order the patient a clear liquid diet until the nausea decreases.
c. Tell the patient that the nausea should subside in about a week.
d. Consult with the health care provider about using a different opioid.

Answer 18

ANS: A
Nausea is frequently experienced with the initiation of opioid therapy, and antiemetics usually are prescribed to treat this expected side effect. The best choice would be to administer the antiemetic medication so the patient can eat. There is no indication that a different opioid is needed, although if the nausea persists, the health care provider may order a change of opioid. Although tolerance develops and the nausea will subside in about a week, it is not appropriate to allow the patient to continue to be nauseated. A clear liquid diet may decrease the nausea but may not provide needed nutrients for injury healing.

Question 19

A patient with terminal cancer–related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first?

a. Use distraction by talking about things the patient enjoys.
b. Suggest the use of alternative therapies such as heat or cold.
c. Administer the prescribed PRN immediate-acting morphine.
d. Consult with the doctor about increasing the MS Contin dose.

Answer 19

ANS: C
The patient’s pain requires rapid treatment, and the nurse should administer the immediate-acting morphine. Increasing the MS Contin dose and use of alternative therapies and distraction may also be needed, but the initial action should be to use the prescribed analgesic medications.

Question 20

Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain?

a. Check the skin under the heating pad.
b. Count the respiratory rate every 2 hours.
c. Ask the patient whether pain control is effective.
d. Monitor sedation using the sedation assessment scale.

Answer 20

ANS: B
Obtaining the respiratory rate is included in UAP education and scope of practice. Assessment for sedation, pain control, and skin integrity requires more education and scope of practice.

Question 21

A patient who is using both a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first?

a. Remove the fentanyl patch.
b. Obtain complete vital signs.
c. Notify the health care provider.
d. Administer prescribed PRN naloxone

Answer 21

ANS: A
The assessment data indicate a possible overdose of opioid. The first action should be to remove the patch. Naloxone administration in a patient who has been chronically using opioids can precipitate withdrawal and would not be the first action. Notification of the health care provider and continued monitoring are also needed, but the patient’s data indicate that more rapid action is needed. The respiratory rate alone is an indicator for immediate action before obtaining blood pressure, pulse, and temperature.

Question 22

The nurse reviews the medication orders for an older patient with arthritis in both hips who reports level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse offer as initial therapy?

a. Naproxen 200 mg orally
b. Oxycodone 5 mg orally
c. Acetaminophen 650 mg orally
d. Aspirin (acetylsalicylic acid) 650 mg orally

Answer 22

ANS: C
Acetaminophen is the best first-choice medication. The principle of “start low, go slow” is used to guide therapy when treating older adults because the ability to metabolize medications is decreased and the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Aspirin and nonsteroidal antiinflammatory drugs are associated with a high incidence of gastrointestinal bleeding in older patients.

Question 23

The nurse on a surgical inpatient unit is caring for several patients. Which patient should the nurse assess first?

a. Patient with postoperative pain who received morphine sulfate IV 15 minutes ago
b. Patient who received hydromorphone (Dilaudid) 1 hour ago and is currently asleep
c. Patient who was treated for pain just prior to return from the postanesthesia care unit
d. Patient with neuropathic pain who is scheduled to receive a dose of hydrocodone (Lortab) now

Answer 23

ANS: C
The risk for oversedation is greatest in the first 4 hours after transfer from the postanesthesia care unit. Patients should be reassessed 30 minutes after receiving IV opioids for pain. A scheduled oral medication does not need to be administered exactly at the scheduled time. A patient who falls asleep after pain medication can be allowed to rest.

Question 24

The health care provider orders a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids before. Which nursing actions regarding opioid administration are appropriate at this time (select all that apply)?

a. Assess for signs that the patient is becoming addicted to the opioid.
b. Monitor for therapeutic and adverse effects of opioid administration.
c. Emphasize that the risk of some opioid side effects increases over time.
d. Teach the patient about how analgesics improve postoperative activity levels.
e. Provide instructions on decreasing opioid doses by the second postoperative day.

Answer 24

ANS: B, D
Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need a decreasing amount of opioids by the second postoperative day, each patient’s response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, so the nurse should not emphasize the adverse effects.

Question 25

A nurse assesses a postoperative patient 2 days after chest surgery. What findings indicate that the patient requires better pain management (select all that apply)?

a. Confusion
b. Hypoglycemia
c. Poor cough effort
d. Shallow breathing
e. Elevated temperature

Answer 25

ANS: A, C, D, E
Inadequate pain control can decrease tidal volume and cough effort, leading to complications such as pneumonia with increases in temperature. Poor pain control may lead to confusion through a variety of mechanism, including hypoventilation and poor sleep quality. Stressors such as pain cause increased release of corticosteroids that can result in hyperglycemia.

Question 26

A patient with chronic pain who has been receiving morphine sulfate 20 mg IV over 24 hours is to be discharged home on oral sustained-release morphine (MS Contin) administered twice a day. What dosage of MS Contin will be needed for each dose to obtain an equianalgesic dose for the patient? (Morphine sulfate 10 mg IV is equianalgesic to morphine sulfate 30 mg orally.)

Answer 26

ANS:
MS Contin 30 mg/dose

Morphine sulfate 20 mg IV over 24 hours will be equianalgesic to MS Contin 60 mg in 24 hours. Because the total dose needs to be divided into two doses, each dose should be 30 mg.

Question 27

The nurse is caring for an unresponsive terminally ill patient who has 20-second periods of apnea followed by periods of deep and rapid breathing. Which action by the nurse would be appropriate?

a. Suction the patient’s mouth.
b. Administer oxygen via face mask.
c. Document Cheyne-Stokes respirations.
d. Place the patient in high Fowler’s position.

Answer 27

ANS: C
Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep and rapid breaths. Cheyne-Stokes respirations are expected in the last days of life and are not position dependent. There is also no need for supplemental oxygen by face mask or suctioning the patient.

Question 28

The nurse is caring for an adolescent patient who is dying. The patient’s parents are interested in organ donation and ask the nurse how the health care providers determine brain death. Which response by the nurse accurately describes brain death determination?

a. “If CPR does not restore a heartbeat, the brain cannot function.”
b. “Brain death has occurred if there is not any breathing or brainstem reflexes.”
c. “Brain death has occurred if a person has flaccid muscles and does not awaken.”
d. “If respiratory efforts cease and no apical pulse is audible, brain death is present.”

Answer 28

ANS: B
The diagnosis of brain death is based on irreversible loss of all brain functions, including brainstem functions that control respirations and brainstem reflexes. The other descriptions describe other clinical manifestations associated with death but are insufficient to declare a patient brain dead.

Question 29

A patient in hospice is manifesting a decrease in all body system functions except for a heart rate of 124 beats/min and a respiratory rate of 28 breaths/min. Which statement, if made by the nurse to the patient’s family member, is most appropriate?

a. “These vital signs will continue to increase until death finally occurs.”
b. “These vital signs are an expected response now but will slow down later.”
c. “These vital signs may indicate an improvement in the patient’s condition.”
d. “These vital signs are a helpful response to the slowing of other body systems.”

Answer 29

ANS: B
An increase in heart and respiratory rate may occur before the slowing of these functions in a dying patient. Heart and respiratory rate typically slow as the patient progresses further toward death. In a dying patient, high respiratory and pulse rates do not indicate improvement or compensation, and it would be inappropriate for the nurse to indicate this to the family.

Question 30

A patient who has been diagnosed with inoperable lung cancer and has a poor prognosis plans a trip across the country “to settle some issues with family members.” The nurse recognizes that the patient is manifesting which psychosocial response to death?

a. Protesting the unfairness of death
b. Anxiety about unfinished business
c. Fear of having lived a meaningless life
d. Restlessness about the uncertainty of prognosis

Answer 30

ANS: B
The patient’s statement indicates that there is some unfinished family business that the patient would like to address before dying. There is no indication that the patient is protesting the prognosis, feels uncertain about the prognosis, or fears that life has been meaningless.

Question 31

A patient with terminal cancer is being admitted to a family-centered inpatient hospice. The patient’s spouse visits daily and cheerfully talks with the patient about wedding anniversary plans for the next year. When the nurse asks about any concerns, the spouse says, “I’m busy at work, but otherwise things are fine.” Which provisional nursing diagnosis is appropriate for the patient’s spouse?

a. Ineffective coping related to lack of grieving
b. Anxiety related to complicated grieving process
c. Hopelessness related to knowledge deficit about cancer
d. Caregiver role strain related to spouse’s complex care needs

Answer 31

ANS: A
The spouse’s behavior and statements indicate the absence of anticipatory grieving, which may lead to impaired adjustment as the patient progresses toward death. The spouse does not appear to feel overwhelmed, hopeless, or anxious.

Question 32

As the nurse admits a patient in end-stage renal disease to the hospital, the patient tells the nurse, “If my heart or breathing stop, I do not want to be resuscitated.” Which action should the nurse take first?

a. Place a “Do Not Resuscitate” (DNR) notation in the patient’s care plan.
b. Invite the patient to add a notarized advance directive in the health record.
c. Advise the patient to designate a person to make future health care decisions.
d. Ask if the decision has been discussed with the patient’s health care provider.

Answer 32

ANS: D
A health care provider’s order should be written describing the actions that the nurses should take if the patient requires CPR, but the primary right to decide belongs to the patient or family. The nurse should document the patient’s request but does not have the authority to place the DNR order in the care plan. A notarized advance directive is not needed to establish the patient’s wishes. The patient may need a durable power of attorney for health care (or the equivalent), but this does not address the patient’s current concern with possible resuscitation.

Question 33

A young adult patient with metastatic cancer, who is very close to death, appears restless. The patient keeps repeating, “I am not ready to die.” Which action is best for the nurse to take?

a. Remind the patient that no one feels ready for death.
b. Sit at the bedside and ask if there is anything the patient needs.
c. Insist that family members remain at the bedside with the patient.
d. Tell the patient that everything possible is being done to delay death.

Answer 33

ANS: B
Staying at the bedside and listening allows the patient to discuss any unresolved issues or physical discomforts that should be addressed. Stating that no one feels ready for death fails to address the individual patient’s concerns. Telling the patient that everything is being done does not address the patient’s fears about dying, especially because the patient is likely to die soon. Family members may not feel comfortable staying at the bedside of a dying patient, and the nurse should not insist that they remain there.

Question 34

The nurse is caring for a terminally ill patient who is experiencing continuous and severe pain. How should the nurse schedule the administration of opioid pain medications?

a. Plan around-the-clock routine administration of analgesics.
b. Provide PRN doses of medication whenever the patient requests them.
c. Suggest small analgesic doses to avoid decreasing the respiratory rate.
d. Offer enough pain medication to keep the patient sedated and unaware of stimuli.

Answer 34

ANS: A
The principles of beneficence and nonmaleficence indicate that the goal of pain management in a terminally ill patient is adequate pain relief even if the effect of pain medications could hasten death. Administration of analgesics on a PRN basis will not provide the consistent level of analgesia the patient needs. Patients usually do not require so much pain medication that they are oversedated and unaware of stimuli. Adequate pain relief may require a dosage that will result in a decrease in respiratory rate.

Question 35

The nurse is caring for a patient with lung cancer in a home hospice program. Which action by the nurse is appropriate?

a. Discuss cancer risk factors and appropriate lifestyle modifications.
b. Teach the patient about the purpose of chemotherapy and radiation.
c. Encourage the patient to discuss past life events and their meanings.
d. Accomplish a thorough head-to-toe assessment several times a week.

Answer 35

ANS: C
The role of the hospice nurse includes assisting the patient with the important end-of-life task of finding meaning in the patient’s life. Frequent head-to-toe assessments are not needed for hospice patients and may tire the patient unnecessarily. Patients admitted to hospice forego curative treatments such as chemotherapy and radiation for lung cancer. Discussion of cancer risk factors and therapies is not appropriate.

Question 36

A hospice nurse who has become close to a terminally ill patient is present in the home when the patient dies and feels saddened and tearful as the family members begin to cry. Which action should the nurse take at this time?

a. Contact a grief counselor as soon as possible.
b. Cry along with the patient’s family members.
c. Leave the home quickly to allow the family to grieve privately.
d. Consider leaving hospice work because patient losses are common.

Answer 36

ANS: B
It is appropriate for the nurse to cry and express sadness in other ways when a patient dies, and the family is likely to feel that this is supportive. Contacting a grief counselor, leaving the family to grieve privately, and considering whether hospice continues to be a satisfying place to work are all appropriate actions as well, but the nurse’s initial action at this time should be to share the grieving process with the family.

Question 37

A middle-aged patient tells the nurse, “My mother died 4 months ago, and I just can’t get over it. I’m not sure it is normal to still think about her every day.” Which nursing diagnosis is most appropriate?

a. Hopelessness related to inability to resolve grief
b. Complicated grieving related to unresolved issues
c. Anxiety related to lack of knowledge about normal grieving
d. Chronic sorrow related to ongoing distress about loss of mother

Answer 37

ANS: C
The patient should be reassured that grieving activities such as frequent thoughts about the deceased are considered normal for months or years after a death. The other nursing diagnoses imply that the patient’s grief is unusual or pathologic, which is not the case.

Question 38

The son of a dying patient tells the nurse, “Mother doesn’t really respond any more when I visit. I don’t think she knows that I am here.” Which response by the nurse is appropriate?

a. “Cut back your visits for now to avoid overtiring your mother.”
b. “Withdrawal can be a normal response in the process of dying.”
c. “Most dying patients don’t know what is going on around them.”
d. “It is important to stimulate your mother so she can’t retreat from you.”

Answer 38

ANS: B
Withdrawal is a normal psychosocial response to approaching death. Dying patients may maintain the ability to hear while not being able to respond. Stimulation will tire the patient and is not an appropriate response to withdrawal in this circumstance. Visitors are encouraged to be “present” with the patient, talking softly and making physical contact in a way that does not demand a response from the patient.

Question 39

Which patient should the nurse refer for hospice care?

a. A 70-yr-old patient with lymphoma whose children are unable to discuss issues related to dying
b. A 60-yr-old patient with chronic severe pain as a result of spinal arthritis and vertebral collapse
c. A 40-yr-old patient with AIDS-related dementia who needs palliative care and pain management
d. A 50-yr-old patient with advanced liver failure whose family members can no longer provide care in the home

Answer 39

ANS: C
Hospice is designed to provide palliative care such as symptom management and pain control for patients at the end of life. Patients who require more care than the family can provide, whose families are unable to discuss important issues related to dying, or who have severe pain are candidates for other nursing services but are not appropriate hospice patients.

Question 40

The nurse admits a terminally ill patient to the hospital. What is the first action that the nurse should complete when planning this patient’s care?

a. Determine the patient’s wishes regarding end-of-life care.
b. Emphasize the importance of addressing any family issues.
c. Discuss the normal grief process with the patient and family.
d. Encourage the patient to talk about any fears or unresolved issues.

Answer 40

ANS: A
The nurse’s initial action should be to assess the patient’s wishes at this time. The other actions may be implemented if the patient or the family express a desire to discuss fears, understand the grief process, or address family issues, but they should not be implemented until the assessment indicates that they are appropriate.

Question 41

Which action is most important for the nurse to take to ensure culturally competent care for an alert, terminally ill Filipino patient?

a. Let the family decide how to tell the patient about the terminal diagnosis.
b. Ask the patient and family about their preferences for care during this time.
c. Obtain information from Filipino staff members about possible cultural needs.
d. Remind family members that dying patients prefer to have someone at the bedside.

Answer 41

ANS: B
Because cultural beliefs may vary among people of the same ethnicity, the nurse’s best action is to assess the expectations of both the patient and family. The other actions may be appropriate, but the nurse can only plan for individualized culturally competent care after assessment of this patient and family.

Question 42

Which nursing actions for the care of a dying patient can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN) (select all that apply)?

a. Provide postmortem care to the patient.
b. Encourage the family members to talk with and reassure the patient.
c. Determine how frequently physical assessments are needed for the patient.
d. Teach family members about commonly occurring signs of approaching death.
e. Administer the prescribed morphine sulfate sublingual as necessary for pain control.

Answer 42

ANS: A, B, E
Medication administration, psychosocial care, and postmortem care are included in LPN/LVN education and scope of practice. Patient and family teaching and assessment and planning of frequency for assessments are skills that require registered nurse level education and scope of practice.

Question 43

A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct?

a. “Benign tumors do not cause damage to other tissues.”
b. “Benign tumors are likely to recur in the same location.”
c. “Malignant tumors may spread to other tissues or organs.”
d. “Malignant cells reproduce more rapidly than normal cells.”

Answer 43

ANS: C
The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors do not metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur.

Question 44

The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?

a. Nausea c. Hematuria
b. Alopecia d. Xerostomia

Answer 44

ANS: C
The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

Question 45

The nurse is caring for a patient who smokes two packs/day. Which action by the nurse could help reduce the patient’s risk of lung cancer?

a. Teach the patient about the seven warning signs of cancer.
b. Plan to monitor the patient’s carcinoembryonic antigen (CEA) level.
c. Teach the patient about annual chest x-rays for lung cancer screening.
d. Discuss risks associated with cigarette smoking during each patient encounter.

Answer 45

ANS: D
Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems. The other options may detect lung cancer that is already present but do not reduce the risk.

Question 46

The nurse should suggest which food choice when providing dietary teaching for a patient scheduled to receive external-beam radiation for abdominal cancer?

a. Fruit salad c. Creamed broccoli
b. Baked chicken d. Toasted wheat bread

Answer 46

ANS: B
Protein is needed for wound healing. To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products should also be avoided.

Question 47

During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next?

a. Obtain more information about the family history.
b. Schedule a sigmoidoscopy to provide baseline data.
c. Teach the patient about the need for a colonoscopy at age 50.
d. Teach the patient how to do home testing for fecal occult blood.

Answer 47

ANS: A
The patient may be at increased risk for colon cancer, but the nurse’s first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning.

Question 48

A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate?

a. “The cancer involves only the cervix.”
b. “The cancer cells look like normal cells.”
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.”

Answer 48

ANS: A
Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread.

Question 49

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was 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.”

Answer 49

ANS: C
A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. A biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient’s life.

Question 50

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient 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 tumor is surgically removed.”
c. “I will need follow-up examinations for many years after treatment before I can be considered cured.”
d. “Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation.”

Answer 50

ANS: C
The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

Question 51

A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure?

a. Pain will be relieved by cutting sensory nerves in the stomach.
b. Relief of pressure in the stomach will promote better nutrition.
c. Decreasing the tumor size will improve the effects of other therapy.
d. Tumor growth will be controlled by the removal of malignant tissue.

Answer 51

ANS: C
A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.

Question 52

External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation?

a. Test all stools for the presence of blood.
b. Maintain a high-residue, high-fiber diet.
c. Clean the perianal area carefully after every bowel movement.
d. Inspect the mouth and throat daily for the appearance of thrush.

Answer 52

ANS: C
Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.

Question 53

A patient with Hodgkin’s lymphoma who is undergoing external radiation therapy tells the nurse, “I am so tired I can hardly get out of bed in the morning.” Which intervention should the nurse add to the plan of care?

a. Minimize activity until the treatment is completed.
b. Establish time to take a short walk almost every day.
c. Consult with a psychiatrist for treatment of depression.
d. Arrange for delivery of a hospital bed to the patient’s home.

Answer 53

ANS: B
Walking programs are used to keep the patient active without excessive fatigue. Having a hospital bed does not necessarily address the fatigue. The better option is to stay as active as possible while combating fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility.

Question 54

The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching?

a. The patient has a history of dental caries.
b. The patient swims several days each week.
c. The patient snacks frequently during the day.
d. The patient showers each day with mild soap.

Answer 54

ANS: B
The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

Question 55

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective?

a. “I can use ice packs to relieve itching.”
b. “I will scrub the area with warm water.”
c. “I can buy aloe vera gel to use on my skin.”
d. “I will expose my skin to a sun lamp each day.”

Answer 55

ANS: C
Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

Question 56

A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken by the nurse, is appropriate?

a. Have the patient eat large meals when nausea is not present.
b. Offer dry crackers and carbonated fluids during chemotherapy.
c. Administer prescribed antiemetics 1 hour before the treatments.
d. Give the patient a glass of a citrus fruit beverage during treatments.

Answer 56

ANS: C
Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach.

Question 57

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?

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 a small-bore catheter.
d. Hold the medication unless a central venous line is available.

Answer 57

ANS: B
Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapy drug. These medications can be given through peripheral lines, although central vascular access devices are preferred.

Question 58

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient’s self-esteem?

a. Encourage the patient to purchase a wig or hat to wear when hair loss begins.
b. Suggest that the patient limit social contacts until regrowth of the hair occurs.
c. Teach the patient to wash hair gently with mild shampoo to minimize hair loss.
d. Inform the patient that hair usually grows back once chemotherapy is complete.

Answer 58

ANS: A
The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicles and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient’s self-esteem.

Question 59

A patient who has ovarian cancer is crying and tells the nurse, “My husband rarely visits. He just doesn’t care.” The husband indicates to the nurse that he does not know what to say to his wife. Which nursing diagnosis is appropriate for the nurse to add to the plan of care?

a. Compromised family coping related to disruption in lifestyle
b. Impaired home maintenance related to perceived role changes
c. Risk for caregiver role strain related to burdens of caregiving responsibilities
d. Dysfunctional family processes related to effect of illness on family members

Answer 59

ANS: D
The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest a change in lifestyle or its role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.

Question 60

A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient?

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.

Answer 60

ANS: D
The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended.

Question 61

A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake?

a. Offer the patient frequent small snacks between meals.
b. Assist the patient to choose favorite foods from the menu.
c. Provide teaching about the importance of nutritional intake.
d. Apply prescribed anesthetic gel to oral lesions before meals.

Answer 61

ANS: D
Because the etiology of the patient’s poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition but would not be as helpful for this patient.

Question 62

A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate?

a. “Don’t you have any friends that will raise the children for you?”
b. “Would you like to talk about options for the care of your children?”
c. “For now you need to concentrate on getting well and not worrying about your children.”
d. “Many patients with cancer live for a long time, so there is time to plan for your children.”

Answer 62

ANS: B
This response expresses the nurse’s willingness to listen and recognizes the patient’s concern. The responses beginning “Many patients with cancer live for a long time” and “For now you need to concentrate on getting well” close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient’s friends will raise the children, more assessment information is needed before making plans.

Question 63

A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective?

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

Answer 63

ANS: C
For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route, and usually the oral route is preferred.

Question 64

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient?

a. IL-2 enhances the body’s immunologic response to tumor cells.
b. IL-2 prevents bone marrow depression caused by chemotherapy.
c. IL-2 protects normal cells from harmful effects of chemotherapy.
d. IL-2 stimulates malignant cells in the resting phase to enter mitosis.

Answer 64

ANS: A
IL-2 enhances the ability of the patient’s own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression.

Question 65

The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment?

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 (Tylenol) every 4 hours.”

Answer 65

ANS: B
Fatigue can be a dose-limiting toxicity for use of immunotherapy. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen every 4 hours.

Question 66

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient’s teaching plan?

a. Donor bone marrow is transplanted through a sternal or hip incision.
b. Hospitalization is required for several weeks after the stem cell transplant.
c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection.
d. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.

Answer 66

ANS: B
The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line so the transplant is not painful, nor is an operating room or incision required.

Question 67

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

a. Lime sherbet c. Fresh strawberries
b. Blueberry yogurt d. Cream cheese bagel

Answer 67

ANS: B
Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt. Cream cheese is low in protein.

Question 68

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action would address the cause of the patient problem?

a. Add protein powder to foods such as casseroles.
b. Tell the patient to eat foods that are high in nutrition.
c. Avoid giving the patient foods that are strongly disliked.
d. Add spices to enhance the flavor of foods that are served.

Answer 68

ANS: C
The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding protein powder does not address the issue of taste. The patient’s poor intake is not caused by a lack of information about nutrition.

Question 69

During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which nursing diagnosis is appropriate for the patient?

a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy
b. Acute confusion related to infiltration of leukemia cells into the central nervous system
c. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment
d. Risk for ineffective health maintenance related to possible anxiety about leukemia diagnosis

Answer 69

ANS: D
The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information. The patient’s history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiologic factors.

Question 70

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?

a. The patient ambulates around the room.
b. The patient’s visitors bring in fresh peaches.
c. The patient cleans with a warm washcloth after having a stool.
d. The patient uses soap and shampoo to shower every other day.

Answer 70

ANS: B
Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help prevent skin breakdown and infection.

Question 71

The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question 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?”

Answer 71

ANS: C
Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient’s need for support. The patient’s knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time.

Question 72

The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider?

a. Generalized muscle aches
b. Crackles heard at the lung bases
c. Complaints of nausea and anorexia
d. Oral temperature of 100.6° F (38.1° C)

Answer 72

ANS: B
Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.

Question 73

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider?

a. Frequent loose stools
b. Nausea and vomiting
c. Elevated white blood count (WBC)
d. Increased carcinoembryonic antigen (CEA)

Answer 73

ANS: D
An increase in CEA indicates that the chemotherapy is not effective for the patient’s cancer and may need to be modified. Gastrointestinal adverse effects are common with chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy. An elevated WBC may indicate infection but does not reflect the effectiveness of the colorectal cancer therapy.

Question 74

The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider?

a. Hematocrit 30%
b. Platelets 95,000/µL
c. Hemoglobin 10 g/L
d. White blood cells (WBC) 2700/µL

Answer 74

ANS: D
The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy.

Question 75

When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?

a. The UAP assists the patient to use dental floss after eating.
b. The UAP adds baking soda to the patient’s saline oral rinses.
c. The UAP puts fluoride toothpaste on the patient’s toothbrush.
d. The UAP has the patient rinse after meals with a saline solution.

Answer 75

ANS: A
Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

Question 76

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention?

a. The UAP flushes the toilet once after emptying the patient’s bedpan.
b. The UAP stands by the patient’s bed for 30 minutes talking with the patient.
c. The UAP places the patient’s bedding in the laundry container in the hallway.
d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.

Answer 76

ANS: B
Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine and feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.

Question 77

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?

a. A 35-yr-old patient who has wet desquamation associated with abdominal radiation
b. A 42-yr-old patient who is sobbing after receiving a new diagnosis of ovarian cancer
c. A 24-yr-old patient who received neck radiation and has blood oozing from the neck
d. A 56-yr-old patient who developed a new pericardial friction rub after chest radiation

Answer 77

ANS: C
Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

Question 78

Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration?

a. Teach the patient to rest the brain by avoiding new activities.
b. Teach that “chemo-brain” is a short-term effect of chemotherapy.
c. Report patient symptoms immediately to the health care provider.
d. Suggest use of a daily planner and encourage adequate rest and sleep.

Answer 78

ANS: D
Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop “chemo-brain” while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short or long term. There is no urgent need to report common chemotherapy side effects to the provider.

Question 79

The nurse assesses a patient with non-Hodgkin’s lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse?

a. Shortness of breath
b. Shivering and chills
c. Muscle aches and pains
d. Temperature of 100.2° F (37.9° C)

Answer 79

ANS: A
Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the health care provider. The other findings will also require action by the nurse, but are not indicative of life-threatening complications.

Question 80

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?

a. Give the patient the prescribed PRN opioid.
b. Assess for sensation and strength in the legs.
c. Notify the health care provider about the symptoms.
d. Teach the patient how to use relaxation to reduce pain.

Answer 80

ANS: B
Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or the use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression.

Question 81

The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider?

a. Hematocrit of 32%
b. Pain with deep inspiration
c. Serum sodium of 126 mEq/L
d. Decreased breath sounds on left side

Answer 81

ANS: C
The syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an oncologic metabolic emergency and requires rapid treatment to prevent complications such as seizures and coma. The other findings also require intervention but are common in patients with lung cancer and not immediately life threatening.

Question 82

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider?

a. Patient complains of severe fatigue.
b. Patient voids every hour during the day.
c. Patient takes only 50% of meals and refuses snacks.
d. Patient has crackles up to the midline posterior chest.

Answer 82

ANS: D
Rapid fluid infusions may cause heart failure, especially in older patients. The other findings are common in patients who have cancer or are receiving chemotherapy.

Question 83

After change-of-shift report on the oncology unit, which patient should the nurse assess first?

a. Patient who has a platelet count of 82,000/µL after chemotherapy
b. Patient who has xerostomia after receiving head and neck radiation
c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C)
d. Patient who is worried about getting the prescribed long-acting opioid on time

Answer 83

ANS: C
Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The other patients also require assessments or interventions but do not need to be assessed as urgently. Patients with thrombocytopenia do not have spontaneous bleeding until the platelets are 20,000/µL. Xerostomia does not require immediate intervention. Although breakthrough pain needs to be addressed rapidly, the patient does not appear to have breakthrough pain.

Question 84

The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine two or three times a week. Which topics will the nurse plan to include in patient 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

Answer 84

ANS: A, C, D, E
The patient’s age, gender, and history indicate a need for screening and teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use tobacco or excessive alcohol, she is physically active, and her body weight is healthy.

Question 85

A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)?

a. Cook food thoroughly before eating.
b. Choose low fiber, low residue foods.
c. Avoid public transportation such as buses.
d. Use rectal suppositories if needed for constipation.
e. Talk to the oncologist before having any dental work.

Answer 85

ANS: A, C, E
Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.