Exam 4 Iggy 10th Ed. Questions Flashcards
Chapter 20 Concepts of Care for Patients With Cancer
Buckle up folks, here we gooooooo!
An 85-year-old client tells the nurse that she does not perform breast self-exam because there is no history of breast cancer in her family. What is the nurse’s best response?
A) “Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now deceased.”
B) “Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age.”
C) “You are correct. Breast cancer is an inherited type of malignancy and your family history indicates low risk for you.”
D) “Examining your breasts once per year when you have your mammogram is sufficient screening for someone with your history.”
B) “Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age.”
The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman.
Which actions or behaviors represent to the nurse that a client is engaging in secondary cancer prevention practices? (Select all that apply.)
A) Eating a diet high in fiber and low in animal fat
B) Having a health checkup, including chest x-ray, annually
C) Obtaining a colonoscopy every 5 years
D) Electing to have both ovaries removed who has a BRCA2 mutation
E) Getting a mammogram or breast MRI annually
F) Having a mole removed from the neck
B) Having a health checkup, including chest x-ray, annually
E) Getting a mammogram or breast MRI annually
Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection.
The nurse is caring for a client with end-stage cancer who needs clarification on the purpose of palliative surgery. Which outcome will the nurse teach the client is the goal of palliative surgery?
A) Prolonging the client’s survival time
B) Relief of symptoms or improved quality of life
C) Allowing other therapies to be more effective
D) Cure of the cancer
B) Relief of symptoms or improved quality of life
The focus and goal of palliative surgery is to help relieve symptoms of end-stage cancer and improve quality of life during the survival time.
Which client statement allows the nurse to recognize whether the client receiving brachytherapy for breast cancer understands the treatment?
A) “I may lose my hair during this treatment.”
B) “I will have a radioactive device in my body for a short time.”
C) “I must be positioned in the same way during each treatment.”
D) “I will be placed in a semiprivate room for company.”
B) “I will have a radioactive device in my body for a short time.”
Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific.
Because radiation therapy is site-specific; this client is unlikely to experience hair loss from treating breast cancer with radiation.
The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.
The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression?
A) Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8%
B) 5000 white blood cells/mm3 (5 × 109/L)
C) 250,000 platelets/mm3 (250 × 109/L)
D) Potassium level of 2.9 mEq/L (2.9 mmol/L) and diarrhea
A) Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8%
Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% has anemia demonstrated by low hemoglobin and hematocrit levels.
The client with diarrhea and a potassium level of 2.9 mEq/L (2.9 mmol/L) has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 (250 × 109/L), and the client with 5000 white blood cells/mm3 (5 × 109/L) demonstrate normal values.
When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful?
A) Providing oral care with a disposable mouth swab
B) Maintaining NPO until the lesions have resolved
C) Encouraging oral care with commercial mouthwash
D) Administering a biological response modifier
A) Providing oral care with a disposable mouth swab
The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care.
Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition and hydration are important during cancer treatment; a local anesthetic may be prescribed.
A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time?
A) Explain that this occurs in some clients and is usually permanent.
B) Inform the client that a small glass of wine may help her relax.
C) Protect the client from infection.
D) Allow the client an opportunity to express her feelings.
D) Allow the client an opportunity to express her feelings.
Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client.
Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.
Which client problem does the nurse determine as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?
A) Potential for injury related to sensory and motor deficits
B) Altered sexual function related to erectile dysfunction
C) Potential for lack of understanding related to side effects of chemotherapy
D) Potential for ineffective coping strategies related to loss of motor control
A) Potential for injury related to sensory and motor deficits
The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client’s safety because of the lack of sensation or innervation to the extremities.
Every chemotherapy client needs to be taught related side effects of chemotherapy. The nurse should address the client’s coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client’s safety.
The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia?
A) Observe for motor deficits.
B) Monitor weight.
C) Monitor platelets.
D) Trend red blood cells and hemoglobin and hematocrit.
B) Monitor weight.
Cachexia results in extreme body wasting, malnutrition, and severe weight loss.
Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.
Which instruction is appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy?
A) Consume a diet high in fiber.
B) Bathe in cold water.
C) Wear cotton gloves when cooking.
D) Make sure shoes are snug.
A) Consume a diet high in fiber.
A high-fiber diet will assist with constipation related to neuropathy.
The client should bathe in warm not cold water, not hotter than 96° F. Cotton gloves may prevent harm from scratching, but protective gloves should be worn for cooking, washing dishes, and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.
Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting?
A) Naloxone
B) Ondansetron
C) Diazepam
D) Morphine
B) Ondansetron
Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Lorazepam, a benzodiazepine, may also be given for nausea.
Morphine is a narcotic analgesic or opiate and may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only.
The RN working on an oncology unit has just received report on these clients. Which client will the nurse assess first?
A) Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy.
B) Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour.
C) Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast.
D) Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature.
D) Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature.
The nurse should see the client with chemotherapy-induced neutropenia first. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people.
The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.
The nurse is teaching a client undergoing radiation therapy for breast cancer. Which potential side effects will the nurse include? (Select all that apply.)
Select all that apply.
A) Fatigue B) Difficulty urinating C) Change in taste D) Difficulty swallowing E) Changes in hair color F) Changes in skin of the breast
A) Fatigue
C) Change in taste ??????
F) Changes in skin of the breast
Radiation therapy to any site produces fatigue in most clients, and may cause clients to report changes in taste. Radiation side effects are site-specific.
Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair, but this does not normally occur with radiation therapy. Difficulty urinating is not a side effect of radiation for breast cancer.
When caring for the client receiving chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.)
A) Bruises B) Fever C) Epistaxis D) Pallor E) Petechiae
A) Bruises
C) Epistaxis
E) Petechiae
Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count (thrombocytopenia).
Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.
When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? (Select all that apply.)
A) Encourage the client to participate in changing the ostomy.
B) Encourage the client and family members to express their feelings and concerns.
C) Offer to have a person who is coping with a colostomy visit with the client.
D) Explain to the client that the colostomy is only temporary.
E) Obtain a psychiatric consultation.
A) Encourage the client to participate in changing the ostomy.
B) Encourage the client and family members to express their feelings and concerns.
C) Offer to have a person who is coping with a colostomy visit with the client.
Encouraging the client to participate in changing the ostomy is an appropriate way for the client to become familiar with the ostomy and its care. A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication.
Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment. Obtaining a psychiatric consultation may need to be done for clients with persistent depression, but would not be done immediately.
The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which intervention does the nurse plan to implement? (Select all that apply.)
A) Do not permit fresh flowers or plants in the room.
B) Do not allow the client’s 16-year-old son to visit.
C) Observe for bleeding.
D) Teach the client to omit raw fruits and vegetables from the diet.
E) Administer pegfilgrastim.
F) Assess for fever.
A) Do not permit fresh flowers or plants in the room.
D) Teach the client to omit raw fruits and vegetables from the diet.
E) Administer pegfilgrastim.
F) Assess for fever.
Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim and pegfilgrastim, is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms.
Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.
The nurse is teaching the client about skin protection during radiation therapy. What teaching will the nurse include? (Select all that apply.)
A) Protect the area by wearing clothing.
B) Avoid all lotions to the area.
C) Avoid exposure to sun and heat.
D) Do not remove the ink markings on your skin.
E) Try to take walks in the early morning or later evening.
F) Do not wash the irradiated area.
A) Protect the area by wearing clothing.
C) Avoid exposure to sun and heat.
D) Do not remove the ink markings on your skin.
E) Try to take walks in the early morning or later evening.
The client can wash the irradiated area daily with either water or a mild soap. Ink or dye used to mark the radiation area should not be removed. The area should be protected by wearing soft clothing over the site, avoiding exposure to the sun and heat. Lotions can be used as long as they are approved by the radiation team. Walking in the early morning or late evening is a good way to avoid more intense sun.
Chapter 49: Concepts of Care for Patients With Oral Cavity and Esophageal Problems
Strong urge to brush my teeth
Which food does the nurse teach a client undergoing chemotherapy with secondary stomatitis to avoid?
A) Broiled fish
B) Ice cream
C) Salted pretzels
D) Scrambled eggs
C) Salted pretzels
Salty foods like pretzels can further irritate ulcers in the client’s mouth, causing pain.
Cool or cold foods and foods high in protein, such as fish, eggs, and ice cream, may be included in the diet of the client with stomatitis.
While undergoing radiation treatment for oral cancer, a client develops xerostomia. What collaborative resource does the nurse suggest for this client’s care?
A) Dentist
B) Occupational therapist
C) Speech therapist
D) Psychiatrist
A) Dentist
Xerostomia is the subjective feeling of oral dryness. It is a long-term effect of radiation therapy and requires ongoing oral care such as the use of saliva substitutes and follow-up dental visits.
Occupational therapists, psychiatrists, and speech therapists are not the appropriate resource for a client with xerostomia.
A client who has undergone surgery and completed radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom?
A) This condition is common but is temporary.
B) Use saliva substitutes, especially when eating dry foods.
C) This indicates a complication of therapy.
D) Use lozenges and hard candies to prevent dry mouth.
B) Use saliva substitutes, especially when eating dry foods.
Xerostomia is a common effect of oral irradiation. Clients should be advised to use saliva substitutes.
The condition is common, but often permanent. Lozenges and hard candies are not as effective as saliva substitutes. Dry mouth is a side effect of therapy, not a symptom of complications. Taking frequent sips of water is the preferred method of treating xerostomia during radiation therapy.
Which practice does the nurse include when teaching a client about proper oral hygiene?
A) Perform self-examination of the mouth every week, and report any unusual findings.
B) Brush the teeth daily and floss as needed.
C) Wear dentures that fit a bit loosely for movement when chewing.
D) Use mouthwash with alcohol unless lesions are present.
A) Perform self-examination of the mouth every week, and report any unusual findings.
The nurse will teach the client that proper oral care involves self-examination of the mouth every week and to report any unusual findings to the Health Care Provider.
Clients need to brush teeth and floss every day—not just as needed. Clients are taught to avoid contact with agents that may cause inflammation of the mouth (such as, alcohol-based mouthwashes). Dentures should fit snugly, not loosely.
The nurse is providing instructions to a client with a history of stomatitis. Which instructions does the nurse include in the teaching plan?
A) Encourage the client to eat acidic foods to decrease bacteria.
B) Mouth care should be performed twice daily at the maximum.
C) Rinse the mouth frequently with warm saline or sodium bicarbonate.
D) Use a medium-bristled toothbrush for oral care.
C) Rinse the mouth frequently with warm saline or sodium bicarbonate.
Rinsing the mouth frequently with warm saline or sodium bicarbonate or a combination of the two decreases inflammation and pain.
Acidic foods increase inflammation and should be avoided. Mouth care should be done after each meal and as often as needed, at the minimum of twice daily. If stomatitis is not controlled, mouth care may have to be done every 2 hours or more frequently. A soft toothbrush, not medium-bristled one, needs to be used for oral care.
When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the assistive personnel (AP)?
A) Instruct how to use nystatin oral rinses.
B) Assist with making appropriate dietary choices that do not irritate tissues.
C) Provide oral care using a soft toothbrush.
D) Inspect the oral mucosa for evidence of oral candidiasis.
C) Provide oral care using a soft toothbrush.
Providing oral care using a soft toothbrush for a client with oral lesions is an appropriate assignment for an AP.
Assessments, client teaching, and assisting clients with oral problems in making appropriate dietary choices are the responsibilities of licensed nursing staff.
The nurse is assessing a client who reports having a history of gastroesophageal reflux disease (GERD). Which assessment finding does the nurse report to the primary health care provider?
A) “My family likes to eat small meals every 3 to 4 hours throughout the day.”
B) “When I buy meat, I ask for the leanest cut that is available.”
C) “I quit smoking 6 months ago.”
D) “Sometimes I wake up gasping for air in the middle of the night.”
D) “Sometimes I wake up gasping for air in the middle of the night.”
Gasping for air upon waking in the middle of the night can be a sign of sleep apnea; the nurse must report this finding to the primary health care provider. Often patients who have one condition (sleep apnea or GERD) also experience the other.
Quitting smoking 6 months ago, eating small meals, and eating lean meats are favorable findings that do not need to be reported.
A client reports ongoing episodes of “heartburn.” Which food will the nurse recommend that the client eliminate from the diet?
A) Steak
B) Carrots
C) Chocolate
D) Popcorn
C) Chocolate
Foods that decrease esophageal sphincter pressure, such as fatty foods, caffeine, and chocolate, should be avoided.
Steak, carrots, and popcorn do not decrease esophageal sphincter pressure.
The nurse is caring for a client diagnosed with aphthous ulcers. Which food will the nurse recommend that the client avoid? (Select all that apply.) A) Apples B) Pasta C) Baked Potato D) Nuts E) Cheese
B) Pasta
C) Baked Potato
D) Nuts
E) Cheese
Aphthous ulcers (canker sores) are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. The nurse tells the client that certain foods such as cheese, nuts, potatoes, and foods containing gluten (like pasta) may trigger allergic responses that cause aphthous ulcers and should be avoided. Apples and bananas are not acidic and do not trigger allergic responses that cause aphthous ulcers.
Chapter 50 Concepts of Care for of Patients With Stomach Disorders
Give me some some, some this of this for my tum. WORK IT. I need a glass of wataaa.
The nurse is caring for a client who has a gastric ulcer. For which potentially life-threatening complication would the nurse monitor for this client?
Hypokalemia
Hemorrhage
Nausea and vomiting
Infection
B) Hemorrhage
Clients who have gastric ulcers are particularly at risk for upper GI bleeding, or hemorrhage. They may also experience nausea and vomiting causing dehydration. However, hemorrhage is most serious.
The nurse is caring for a client with peptic ulcer disease who has been vomiting profusely at home before coming to the emergency department. For which acid–base imbalance will the nurse expect for this client?
Respiratory acidosis
Respiratory alkalosis
Metabolic alkalosis
Metabolic acidosis
C) Metabolic alkalosis
Gastric contents are rich in acid (hydrogen and chloride ions). When this fluid is lost through vomiting, the client has less acid causing an alkalotic state.
The nurse is caring for a client with peptic ulcer disease who has been vomiting profusely at home before coming to the emergency department. For which vital sign change will the nurse expect for this client?
Hypotension
Tachypnea
Oxygen desaturation
Bradycardia
A) Hypotension
The client who is vomiting profusely is losing fluids from the body causing dehydration. A client who is dehydrated has hypovolemia resulting in hypotension and tachycardia.
A client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse’s best response?
“No, they probably won’t be useful. You should use only prescription medications in your treatment plan.”
“These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen.”
“No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe.”
“Yes, these are known to be effective in managing this disease but make sure you research the herbs thoroughly before taking them.”
B) “These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen.”
The nurse’s best response is that although licorice and slippery elm may be helpful in managing PUD, the client must consult his or her primary health care provider before making a change in the treatment regimen.
Alternative therapies may or may not be helpful in managing PUD. The client should not use over-the-counter medications without first discussing it with his or her primary health care provider.
