TEST 13: The Client with Cancer

Question 1

The Client at Risk for Cancer
1. The nurse is preparing an educational program on breast cancer for women at a Black
community center. What information is important for the nurse to consider for the discussion?
1. Black women have the lowest rate of breast cancer.
2. Most Black women are diagnosed early in the disease process.
3. Breast cancer concerns vary between socioeconomic levels of Black women.
4. Black women believe breast cancer is inevitable.

Answer 1

The Client at Risk for Cancer
1. 3. The nurse needs to consider the beliefs and concerns for all socioeconomic levels of Black
women when providing education on breast cancer. Access to screening and care may differ. Black
women are more likely to develop breast cancer and be diagnosed later in the disease process than
Caucasian women. Not all Black women believe that breast cancer is inevitable.
CN: Health promotion and maintenance; CL: Synthesize

Question 2

2. Which of the following clients is at highest risk for colorectal cancer?
3. The client who smokes.
4. The client who eats a vegetarian diet.
5. The client who has been treated for Crohn’s disease for 20 years.
6. The client who has a family history of lung cancer.

Answer 2

2. 3 Clients over age 50 who have a history of inflammatory bowel disease are at risk for colon
   cancer. The client who smokes is at high risk for lung cancer. While the exact cause is not always
   known, other risk factors for colon cancer are a diet high in animal fats, including a large amount of
   red meat and fatty foods with low fiber, and the presence of colon cancer in a first-generation
   relative.
   CN: Reduction of risk potential; CL: Analyze

Question 3

3. A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of
   possible lymphoma. Which statement made by the client demonstrates proper understanding of
   discharge teaching? Select all that apply.
4. “I will take Tylenol for pain.”
5. “I do not need to inspect the puncture site.”
6. “I will not be able to play basketball for the next 2 days.”
7. “I will take aspirin if I have pain.”
8. “I can apply an ice pack or a cold compress to the puncture site.”

Answer 3

3. 1, 3, 5. Acetaminophen (Tylenol) is a safer analgesic than aspirin in order to avoid bleeding.
   Contact sports or trauma to the site should be avoided. Cool compresses should limit swelling and
   bruising. The puncture site should be inspected every 2 hours for bleeding or bruising during the first
   24 hours.
   CN: Reduction of risk potential; CL: Evaluate

Question 4

4. A nurse is conducting a cancer risk screening program. Which of the following clients is at
greatest risk for skin cancer?
1. 45-year-old physician.
2. 15-year-old high school student.
3. 30-year-old butcher.
4. 60-year-old mountain biker.

Answer 4

4. 4. Basal cell carcinoma occurs most commonly in sun-exposed areas of the body. The
      incidence of skin cancer is highest in older people who live in the mountains or spend outdoor leisure
      time at higher altitudes.
      CN: Health promotion and maintenance; CL: Analyze

Question 5

5. A client diagnosed with testicular cancer expresses concerns about fertility. The couple
   desires to eventually have a family and the nurse discusses the option of sperm banking. The nurse
   should inform the couple that sperm banking would need to be performed:
6. Before treatment is started.
7. Once the client is tolerating the treatment.
8. Upon completion of treatment.
9. When tumor markers drop to normal levels.

Answer 5

5. 1. Because of the high risk of infertility with chemotherapy, pelvic irradiation, and
      retroperitoneal lymph node dissection that may follow an orchiectomy, cryopreservation of sperm is
      completed before treatment is started and should be discussed with the client.
      CN: Physiological adaptation; CL: Apply

Question 6

6. Cancer prevalence is defined as:
7. The likelihood cancer will occur in a lifetime.
8. The number of persons with cancer at a given point in time.
9. The number of new cancers in a year.
10. All cancer cases more than 5 years old.

Answer 6

6. 2. The word prevalence in a statistical setting is defined as the number of cases of a disease
      present in a specified population at a given time.
      CN: Health promotion and maintenance; CL: Apply

Question 7

7. Which of the following groups would benefit most from education regarding potential risk
   factors for melanoma?1. Adults older than age 35.
8. Senior citizens who have been repeatedly exposed to the effects of ultraviolet A and ultraviolet
   B rays.
9. Parents with children.
10. Employees of a chemical factory.

Answer 7

7. 3. Sun damage is a cumulative process. Parents should be taught to apply sunscreen and teach
      their children to use sunscreen at an early age. Although preventive education is always valuable,serious sunburns in childhood are associated with an increased risk of melanoma. Adults and senior
      citizens have already been exposed to the harmful effects of the sun and, although they, too, should use
      sunscreen, they are not the group that will most benefit from intervention. Exposure to chemicals is
      not a risk factor for melanoma.
      CN: Health promotion and maintenance; CL: Analyze

Question 8

8. A nurse is providing education in a community setting about general measures to avoid
   excessive sun exposure. Which of the following recommendations is appropriate?
9. Apply sunscreen only after going into the water.
10. Avoid peak exposure hours from 9 AM to 1 PM .
11. Wear loosely woven clothing for added ventilation.
12. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

Answer 8

8. 4. A sunscreen with an SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It
      should be applied before sun exposure and reapplied after being in the water. Peak sun exposure
      usually occurs from 10 AM to 2 PM . Tightly woven clothing, protective hats, and sunglasses are
      recommended to decrease sun exposure. Suntanning parlors should be avoided.
      CN: Health promotion and maintenance; CL: Synthesize

Question 9

9. A 29-year-old woman is concerned about her personal risk factors for malignant melanoma.
   She is upset because her 49-year-old sister was recently diagnosed with the disease. After gathering
   information about the client’s history of sun exposure, the nurse’s best response would be to explain
   that:
10. Some melanomas have a familial component, and she should seek medical advice.
11. Her personal risk is low because most melanomas occur at age 60 or later.
12. Her personal risk is low because melanoma does not have a familial component.
13. She should not worry because she did not experience severe sunburn as a child

Answer 9

9. 1. Malignant melanoma may have a familial basis, especially in families with dysplastic nevi
      syndrome. First-degree relatives should be monitored closely. Malignant melanoma occurs most often
      in the 20- to 45-year-old age-group. Severe sunburn as a child does increase the risk; however, this
      client is at increased risk because of her family history.
      CN: Health promotion and maintenance; CL: Apply

Question 10

10. A nurse is palpating a female client’s breast while assessing for breast disease. In the
    illustration below, indicate the area of the breast in which tumors are most commonly found.

Answer 10

10. The upper outer quadrant is the area of the breast in which most breast tumors are found. This
    area should be palpated thoroughly. Although breast tumors can be found in any area of the breast,
    including the nipple, the tumors are most often in the upper outer quadrant.

CN: Health promotion and maintenance; CL: Apply

Question 11

11. The nurse is teaching a 17-year-old, sexually active female client about the importance of
    regular Papanicolaou (Pap) smears. The nurse should instruct the client that:
12. Pap smears are recommended every other year.
13. If four consecutive annual Pap smears are negative, the client should schedule repeat Pap
    smears every 3 years.
14. The initial Pap smear should be done when at age 21.4. The client should request a colposcopy.

Answer 11

11. 3. The American and Canadian Cancer Societies, American College of Obstetricians and
       Gynecologists, and Society of Obstetricians and Gynecologists of Canada recommend a Pap smear
       and pelvic examination 3 years after a woman first has vaginal intercourse, but no later than 21 years
       of age. Annual Pap smears are recommended only for clients at risk. Women 21 to 30 years should
       have a Pap test every 2 years. Women older than 30 years, after three or more negative Pap smears,may have a Pap smear every 3 years. Colposcopy is indicated for clients with an abnormal Pap
       smear.
       CN: Health promotion and maintenance; CL: Apply

Question 12

12. A client with a family history of cancer asks the nurse what the single most important risk
    factor is for cancer. Which of the following risk factors should the nurse discuss?
13. Family history.
14. Lifestyle choices.
15. Age.
16. Menopause or hormonal events.

Answer 12

12. 3. Because more than 50% of the cancers occur in people who are older than age 65, the
       single most important factor in determining risk would be age.
       CN: Health promotion and maintenance; CL: Apply

Question 13

13. Experimental and epidemiologic evidence suggests that a high-fat diet increases the risk of
    several cancers. Which of the following cancers is linked to a high-fat diet?
14. Ovarian.
15. Lung.
16. Colon.
17. Liver.

Answer 13

13. 3. Evidence suggests that a high-fat diet increases the risk of several cancers, including breast,
       colon, and prostate cancers. Ovarian, lung, and liver cancers have not been linked to a high-fat diet.
       CN: Health promotion and maintenance; CL: Apply

Question 14

14. A 42-year-old female highway construction worker is concerned about her cancer risks. She
    has been married for 18 years, has two children, smokes one pack of cigarettes per day, and
    occasionally drinks one to two beers. She is 30 lb (13.6 kg) overweight, eats fast food often, and
    rarely eats fresh fruits and vegetables. Her mother was diagnosed with breast cancer 2 years ago. Her
    father and an aunt both died of lung cancer. She had a basal cell carcinoma removed from her cheek 3
    years earlier. What behavioral changes should the nurse instruct this client to make to decrease her
    risk of cancer? Select all that apply.
15. Improve nutrition.
16. Decrease alcohol consumption.
17. Use sunscreen.
18. Stop smoking.
19. Lose weight.
20. Change her job to work inside.

Answer 14

14. 1, 3, 4, 5. The client is at increased risk for development of lung, skin, or breast cancer.
    Consequently, the client should improve nutrition (eg, eating low-fat foods, increasing fiber), stop
    smoking, use sunscreen, and lose weight. The client’s alcohol consumption is not excessive and not a
    risk. It is not necessary and would be difficult for the client to change jobs to work inside as long as
    the client uses protection from the sun.
    CN: Health promotion and maintenance; CL: Synthesize

Question 15

15. The incidence and risk of cancer increase when smoking is combined with:
16. Asbestos exposure and alcohol consumption.
17. Ultraviolet radiation exposure and alcohol consumption.
18. Asbestos exposure and ultraviolet radiation exposure.
19. Alcohol consumption and human papillomavirus (HPV) infection.

Answer 15

15. 1. Asbestos and alcohol, when combined with smoking, produce a synergistic effect and result
       in increased cancer risk and incidence. Ultraviolet radiation exposure is associated with skin cancer.
       HPV exposure is associated with cervical cancer. However, the risks of contracting these types of
       cancer are not markedly increased when combined with smoking.
       CN: Health promotion and maintenance; CL: Apply

Question 16

16. The nurse is assessing a 60-year-old who has hoarseness. The nurse should conduct a
    focused assessment to determine:
17. Patterns of medication use and history of alcohol consumption.
18. Exposure to sun and family history of head and neck cancers.
19. Exposure to wood dust and a high-fat diet.
20. History of tobacco use and alcohol consumption.

Answer 16

16. 4. Although exposure to the sun increases the risk of skin cancers and family history is
       significant in the development of some types of cancer, heavy tobacco use and alcohol intake have a
       synergistic effect and increase the risk and incidence of head and neck cancers. Patterns of medication
       use, exposure to wood dust, and a high-fat diet are not associated with an increased risk and
       incidence of head and neck cancers.
       CN: Health promotion and maintenance; CL: Analyze

Question 17

17. A 42-year-old is interested in making dietary changes to reduce the risk of colon cancer.
    What dietary selections should the nurse suggest?
18. Croissant, granola and peanut butter squares, whole milk.
19. Bran muffin, skim milk, stir-fried broccoli.
20. Granola, bagel with cream cheese, cauliflower salad.4. Oatmeal, raisin cookies, baked potato with sour cream, turkey sandwich.

Answer 17

17. 2. High-fiber, low-fat diets are recommended to reduce the risk of colon cancer. Stir-frying,
       poaching, steaming, and broiling are all low-fat methods to prepare foods. Croissants are made of
       refined flour. They are also high in fat, as are peanut butter squares and whole milk, granola, cream
       cheese, and sour cream.
       CN: Health promotion and maintenance; CL: Apply

Question 18

18. Which of the following is an environmental factor that increases the risk of cancer?
19. Gender.
20. Nutrition.
21. Immunologic status.
22. Age.

Answer 18

18. 2. Environmental factors include place of residence, nutrition, occupation, personal habits,
       iatrogenic factors, and physical environment. Gender, immunologic status, and age are individual
       factors.
       CN: Health promotion and maintenance; CL: Apply

Question 19

19. A client at risk for lung cancer asks about the reason for having a computed tomography (CT)
    scan as part of the initial exam. The nurse’s best response is which of the following? “A CT scan
20. Is far superior to magnetic resonance imaging for evaluating lymph node metastasis.”
21. Is noninvasive and readily available.”
22. Is useful for distinguishing small differences in tissue density and detecting nodal
    involvement.”
23. Can distinguish a malignant from a nonmalignant adenopathy.”

Answer 19

19. 3. CT scanning is the standard noninvasive method used in a workup for lung cancer because
       it can distinguish small differences in tissue density and can detect nodal involvement. CT is
       comparable to magnetic resonance imaging in evaluating lymph node metastasis. CT is noninvasive
       and usually available, but these are not the main reasons for its use. CT can distinguish malignancy in
       some situations only.CN: Physiological adaptation; CL: Synthesize

Question 20

20. Lifestyle influences that are considered risk factors for colorectal cancer include:
21. A diet low in vitamin C.
22. A high dietary intake of artificial sweeteners (Aspartame).
23. A high-fat, low-fiber diet.
24. Multiple sex partners.

Answer 20

20. 3. A high-fat, low-fiber diet is a risk factor for colorectal cancer. A diet low in vitamin C, use
       of artificial sweeteners, and multiple sex partners are not considered risk factors for colorectal
       cancer.
       CN: Health promotion and maintenance; CL: Analyze

Question 21

21. When planning a culturally sensitive health education program the nurse should:
22. Locate the program at an existing government facility.
23. Integrate folk beliefs and traditions of the target population into the content.
24. Prepare materials in the primary language of the program sponsor.
25. Exclude community leaders from the dominant culture from initial planning efforts.

Answer 21

21. 2. Strategies to reach clients in all cultures should include incorporating the folk beliefs and
       traditions of the target population into the program. Identification of a centrally located building with
       available access by the target population, use of materials in the native or primary language of the
       target population, and involvement by all community leaders will also help the program succeed.
       CN: Health promotion and maintenance; CL: Synthesize

Question 22

The Client with Pain
22. A client in a hospice program has increasing pain. The nurse and client collaborate to
schedule analgesics to provide which of the following?
1. Doses of analgesic when pain is a “5” on a scale of 1 to 10.
2. Enough analgesia to keep the client semi-somnolent.
3. An analgesia-free period so that the client can carry out daily hygienic activities.
4. Around-the-clock routine administration of analgesics for continuous pain relief.

Answer 22

The Client with Pain
22. 4. The desired outcome for management of pain is that the client’s or family’s subjective report
of pain is acceptable and documented using a pain scale; the goal is that behavioral and physiologic
indicators of pain are absent around the clock. The nurse and client/family should develop a
systematic approach to pain management using information gathered from history and a hierarchy of
pain measurement. Pain should be assessed at frequent intervals. The client should not wait to receive
medication until the pain is midpoint on the pain scale, nor should the client receive so much pain
medication that he or she is not alert. Continuous pain relief is the goal, not just during particular
periods during the day.
CN: Basic care and comfort; CL: Synthesize

Question 23

23. A client with pancreatic cancer has been receiving morphine via a subcutaneous pump for 2
    weeks. The client is requiring an increased dose of the morphine to manage the pain. The nurse
    should document that the client is:
24. Tolerating the medication well.
25. Showing addiction to morphine.
26. Developing a tolerance for the medication.
27. Experiencing physical dependence.

Answer 23

23. 3. Tolerance develops from taking opioids over an extended period. It is characterized by the
       need for an increased dose to achieve the same degree of analgesia. Addiction is characterized by a
       drive to take the medication for the psychic effect rather than the therapeutic effect. Physical
       dependence is a response to ongoing exposure to a medication manifested by withdrawal symptoms
       when discontinued abruptly.
       CN: Pharmacological and parenteral therapies; CL: Analyze

Question 24

24. A client with advanced ovarian cancer takes 150 mg of long-acting morphine orally every 12
    hours for abdominal pain. When the client develops a small bowel obstruction, the physician
    discontinues the oral morphine and begins morphine 6 mg/h IV. After calculating the equianalgesic
    conversion from oral to intravenous morphine, the nurse should:
25. Continue the oral morphine for one more dose after the IV morphine is started.
26. Contact the physician to suggest a higher equianalgesic dose of IV morphine.
27. Administer the morphine IV as prescribed.
28. Clarify the prescription to recommend the initial morphine dose of 4 mg/h.

Answer 24

24. 4. The conversion ratio for morphine is 10 mg IV equals 30 mg oral, or 1:3. The client is
       receiving 300 mg orally per 24 hours, which is equivalent to 100 mg of IV morphine. Morphine 100
       mg IV/24 hours = approximately 4 mg/h IV. The effect of the IV morphine is quick and the oral
       morphine should be discontinued prior to starting the IV morphine. Morphine at 6 mg or higher are
       above the initial conversion dose from oral to IV and can cause untoward side effects.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 25

25. A client had a craniotomy for removal of a malignant brain tumor in the occipital region. The
    nurse should question a prescription for which of these drugs?
26. Ibuprofen (Motrin).
27. Naproxen (Naprosyn).
28. Morphine sulfate.
29. Acetaminophen (Tylenol).

Answer 25

25. 3. Administration of morphine sulfate is contraindicated because morphine causes respiratory
       depression. It may also increase intracranial pressure if the client is not ventilating properly, which
       could result in an accumulation of CO 2 , a potent vasodilator. Ibuprofen, naproxen, and acetaminophen
       are not likely to mask symptoms of increased intracranial pressure or impact respiratory status.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 26

26. A 62-year-old female is taking long-acting morphine 120 mg every 12 hours for pain from
    metastatic breast cancer. She can have 20 mg of immediate-release morphine every 3 to 4 hours as
    needed for breakthrough pain. The physician should be notified if the client uses more than how many
    breakthrough doses of morphine in 24 hours?
27. Seven.
28. Four.
29. Two.
30. One.

Answer 26

26. 1. If the maximum dose specified by the physician’s prescription is required every 3 to 4 hours
       for breakthrough pain, the physician should be notified to increase the long-acting medication orrotate to another type of opioid. Around-the-clock dosing is mandatory to achieve a steady state of
       analgesia. The rescue dose for breakthrough pain is administered over and above the regularly
       scheduled medication. If three to four analgesic doses are required every 24 hours, the sustained-
       release around-the-clock dose should be increased to include the amount used for previous
       breakthrough pain while maintaining a dose for future breakthrough pain.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 27

27. Assessment of a client taking a nonsteroidal anti-inflammatory drug (NSAID) for pain
    management should include specific questions regarding which of the following systems?
28. Gastrointestinal.
29. Renal.
30. Pulmonary.4. Cardiac.

Answer 27

27. 1. The most common toxicities from NSAIDs are gastrointestinal disorders (nausea, epigastric
       pain, ulcers, bleeding, diarrhea, and constipation). Renal dysfunction, pulmonary complications, and
       cardiovascular complications from NSAIDs are much less common.
       CN: Pharmacological and parenteral therapies; CL: Analyze

Question 28

28. The nurse is assessing a client with chronic pain. Which of the following is an expected
    response of a client in chronic pain?
29. Elevated vital signs, physical inactivity, facial grimacing, and periods of anxiety.
30. Normal vital signs, physical inactivity, and normal facial expressions.
31. Normal vital signs, normal facial expressions, and moaning.
32. Elevated vital signs, grimacing, and depression.

Answer 28

28. 2. In the client with chronic pain, physiologic adaptation results in minimal changes in
       behavior and vital signs. Elevated vital signs, grimacing, and moaning are characteristic responses to
       acute pain.
       CN: Basic care and comfort; CL: Analyze

Question 29

29. Which of the following terms describes the condition of a client who requires an increase in
dosage to maintain adequate analgesia?
1. Pseudoaddiction.
2. Physical dependence.
3. Psychological dependence.
4. Drug tolerance.

Answer 29

29. 4. Tolerance is a reduced responsiveness to the effect of any drug, which necessitates larger
       doses to achieve an equivalent effect of the initial dose. Pseudoaddiction is a term used to describe
       the iatrogenic syndrome of drug-seeking behavior that develops as a direct consequence of inadequate
       pain management. Physical dependence refers to the state in which an individual must take the
       substance to feel physically normal; not taking the drug results in withdrawal symptoms.
       Psychological dependence refers to an individual’s need to derive an alteration in mood from a
       substance.
       CN: Basic care and comfort; CL: Apply

Question 30

30. A client with lung cancer is being cared for by his wife at home. His pain is increasing in
    severity. The nurse recognizes that teaching has been effective when the wife does which of the
    following? Select all that apply.
31. Administers long-acting or sustained-release oral pain medication (OxyContin) regularly
    around the clock.
32. Administers immediate-release medication (oxycodone) for breakthrough pain.
33. Avoids long-acting opioids due to her concern about addiction.
34. Uses music for distraction as well as heat or cold in combination with medications.
35. Substitutes acetaminophen (Tylenol) to avoid tolerance to the medications.
36. Has her husband use a pain-rating scale to measure the effectiveness at reaching his individual
    pain goal.

Answer 30

30. 1, 2, 4, 6. Scheduled use of long-acting opioids (MS Contin, OxyContin) and an around-the-
    clock dosing are necessary to achieve a steady level of analgesia. Whatever the route or frequency, a
    prescription should be available for “breakthrough” pain medication to be administered in addition to
    the regularly scheduled medication. Oral drug administration is the route of choice for economy,
    safety, and ease of use. Even severe pain requiring high doses of opioids can be managed orally as
    long as the client can swallow medication and has a functioning gastrointestinal system. Tolerance
    occurs due to the need for increasing doses to achieve the same pain relief and will not be avoided
    with the use of Tylenol. Addiction is a complex condition in which the drug is used for psychological
    effect and not analgesia. Nurses need to educate families about the appropriate use of opioids and
    assure them that addiction is not a concern when managing cancer pain. Nonpharmacologic methods
    are useful as an adjunct to assist in pain control. Self-report is the best assessment of pain and is an
    individual response.
    CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 31

31. A 52-year-old male was discharged from the hospital for cancer-related pain. His pain
    appeared to be well controlled on the IV morphine. He was switched to oral morphine when
    discharged 2 days ago. He now reports his pain as an 8 on a 10-point scale and wants the IV
    morphine. Which of the following represents the most likely explanation for the client’s reports of
    inadequate pain control?
32. He is addicted to the IV morphine.
33. He is going through withdrawal from the IV opioid.
34. He is physically dependent on the IV morphine.
35. He is undermedicated on the oral opioid.

Answer 31

1. 4. Most clients with cancer who are experiencing inadequate pain control while taking an oral
      opioid after being switched from IV administration have been undermedicated. Equianalgesic
      conversions should be made to provide estimates of the equivalent dose needed for the same level of
      relief as provided by the IV dose. There is research to suggest that cancer clients do not become
      addicted to opioids when dosed adequately. There is no evidence to suggest that the client is
      physically addicted or is having withdrawal symptoms.CN: Pharmacological and parenteral therapies; CL: Analyze

Question 32

32. A nurse is assessing a client with bone cancer pain. Which of the following components of a
    thorough pain assessment is most significant for this client?
33. Intensity.
34. Cause.
35. Aggravating factors.
36. Location.

Answer 32

32. 1. Intensity is indicative of the severity of pain and is important for evaluating the efficacy of
       pain management. The cause and location of the pain cannot be managed, but the intensity of the pain
       can be controlled. The nurse and client can collaborate to reduce aggravating factors; however, the
       goal will ultimately be to reduce the intensity of the pain.
       CN: Basic care and comfort; CL: Analyze

Question 33

33. A 48-year-old client with cancer has been receiving 10 mg of IV morphine while
    hospitalized. Which of the following is an equivalent dose of oral morphine?
34. 20 mg.2. 30 mg.
35. 40 mg.
36. 50 mg.

Answer 33

33. 2. There is a 1:3 ratio with equianalgesic dosing of IV to oral morphine; therefore, the
       physician should prescribe three times the IV dose.
       CN: Pharmacological and parenteral therapies; CL: Apply

Question 34

34. Which of the following reasons explains why meperidine (Demerol) is not recommended for
    chronic cancer-related pain?
35. It has a high potential for abuse.
36. It has agonist-antagonist properties.
37. It must be given intramuscularly to be effective.
38. It contains a metabolite that causes seizures.

Answer 34

34. 4. Normeperidine, which is a potent long-acting metabolite of meperidine, can cause central
       nervous system (CNS) stimulation and seizures. Meperidine is a short-acting drug and must be given
       in more frequent intervals and may require increased dosages for effectiveness. Mixed agonist-
       antagonists act competitively at different pain receptor sites. It is generally accepted by cancer pain
       experts that opioid agonist-antagonist drugs have very limited usefulness in cancer pain management
       because of their tendency to induce opioid withdrawal and cause severe CNS adverse effects.
       Meperidine does not have a higher potential for abuse than other opioids. There are other routes of
       meperidine administration, so the route of administration is not the limiting factor.
       CN: Pharmacological and parenteral therapies; CL: Apply

Question 35

35. A client with chronic cancer pain has been receiving opiates for 4 months. She rated the pain
    as an 8 on a 10-point scale before starting the opioid medication. Following thorough examination,
    there is no new evidence of increased disease, yet the pain is close to 8 again. The most likely
    explanation for the increasing pain is:
36. Development of an addiction to the opioids.
37. Tolerance to the opioid.
38. Withdrawal from the opioid.
39. Placebo effect has decreased.

Answer 35

35. 2. Tolerance to an opioid occurs when a larger dose of the analgesic is needed to provide the
       same level of pain control. The risk of addiction is low with opioids to treat cancer pain. There are
       no data to support that this client is experiencing withdrawal. Although the client may have
       experienced a placebo effect at one time, placebo effects tend to diminish over time, especially in
       regard to chronic cancer pain.
       CN: Pharmacological and parenteral therapies; CL: Analyze

Question 36

36. The nurse teaches the client with chronic cancer pain about optimal pain control. Which of
    the following recommendations is most effective for pain control?
37. Get used to some pain and use a little less medication than needed to keep from being
    addicted.
38. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain.
39. Take analgesics only when pain returns.
40. Take enough analgesics around the clock so that you can sleep 12 to 16 hours a day to block the
    pain.

Answer 36

36. 2. The regular administration of analgesics provides a consistent serum level of medication,
       which can help prevent breakthrough pain. Therefore, taking the prescribed analgesics on a regular
       schedule is the best way to manage chronic cancer-related pain. There is little risk for the client with
       cancer-related pain to become addicted. Sleeping 12 to 16 hours a day would not allow the client to
       participate in usual daily activities or preferred activities.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 37

The Client Who Is Receiving Chemotherapy
37. Doxorubicin (Adriamycin) is prescribed for a female client with breast cancer. The client is
distressed about hair loss. The nurse should do which of the following?
1. Have the client wash and massage the scalp daily to stimulate hair growth.
2. Explain that hair loss is temporary and will quickly grow back to its original appearance.
3. Provide resources for a wig selection before hair loss begins.
4. Recommend that the client limit social contacts until hair regrows.

Answer 37

The Client Who Is Receiving Chemotherapy
37. 3. Resources should be provided for acquiring a wig since it is easier to match hair style and
color before hair loss begins. The client has expressed negative feelings of self-image with hair loss.
Excessive shampooing and manipulation of hair will increase hair loss. Hair usually grows back in 3
to 4 weeks after the chemotherapy is finished; however, new hair may have a new color or texture. A
wig, hairpiece, hat, scarf, or turban can be used to conceal hair loss. Social isolation should be
avoided and the client should be encouraged to socialize with others.
CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 38

38. A client is receiving chemotherapy for the diagnosis of brain cancer. When teaching the client
    about contamination from excretion of the chemotherapy drugs within the first 48 hours, the nurse
    should instruct the client that:
39. A bathroom can be shared with an adult who is not pregnant.
40. Urinary and bowel excretions are not considered contaminated.
41. Disposable plates and plastic utensils must be used during the entire course of chemotherapy.
42. Any contaminated linens should be washed separately and then washed a second time, if
    necessary.

Answer 38

38. 4. The client may excrete the chemotherapeutic agent for 48 hours or more afteradministration. Blood, emesis, and excretions may be considered contaminated during this time, and
       the client should not share a bathroom with children or pregnant women. Any contaminated linens or
       clothing should be washed separately and then washed a second time, if necessary. All contaminated
       disposable items should be sealed in plastic bags and disposed of as hazardous waste.
       CN: Physiological integrity; CL: Synthesize

Question 39

39. A client is receiving vincristine. Client teaching by the nurse should include instructions on:
40. Use of loperamide.
41. Fluid restriction.
42. Low-fiber, bland diet.
43. Bowel regimen.

Answer 39

39. 4. A side effect of vincristine is constipation, and a bowel protocol should be considered.
       Loperamide is used to treat diarrhea. Fluids should be encouraged, along with high-fiber foods to
       prevent constipation.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 40

40. The client who is receiving chemotherapy is not eating well but otherwise feels healthy.
    Which meal suggestion would be best for this client?
41. Cereal with milk and strawberries.
42. Toast, gelatin dessert, and cookies.
43. Broiled chicken, green beans, and cottage cheese.
44. Steak and french fries.

Answer 40

40. 3. Carbohydrates are the first substance used by the body for energy. Proteins are needed to
       maintain muscle mass, repair tissue, and maintain osmotic pressure in the vascular system. Fats, in a
       small amount, are needed for energy production. Chicken, green beans, and cottage cheese are the
       best selection to provide a nutritionally well-balanced diet of carbohydrate, protein, and a small
       amount of fat. Cereal with milk and strawberries as well as toast, gelatin dessert, and cookies have a
       large amount of carbohydrates and not enough protein. Steak and french fries provide some
       carbohydrates and a good deal of protein; however, they also provide a large amount of fat.
       CN: Health promotion and maintenance; CL: Synthesize

Question 41

41. A nurse is assessing a female who is receiving her second administration of chemotherapy for
    breast cancer. When obtaining this client’s health history, what is the most important information the
    nurse should obtain?
42. “Has your hair been falling out in clumps?”
43. “Have you had nausea or vomiting?”
44. “Have you been sleeping at night?”
45. “Do you have your usual energy level?”

Answer 41

41. 2. Chemotherapy agents typically cause nausea and vomiting when not controlled by
       antiemetic drugs. Antineoplastic drugs attack rapidly growing normal cells, such as in the
       gastrointestinal tract. These drugs also stimulate the vomiting center in the brain. Hair loss, loss of
       energy, and sleep are important aspects of the health history, but not as critical as the potential for
       dehydration and electrolyte imbalance caused by nausea and vomiting.
       CN: Pharmacological and parenteral therapies; CL: Analyze

Question 42

42. A client is receiving monthly doses of chemotherapy for treatment of stage III colon cancer.
    The nurse should report which of the following laboratory results to the oncologist before the next
    dose of chemotherapy is administered? Select all that apply.
43. Hemoglobin of 14.5 g/dL (145 g/L).
44. Platelet count of 40,000/mm 3 (40 × 10 9 /L).
45. Blood urea nitrogen (BUN) level of 12 mg/dL (4.28 mmol/L).
46. White blood cell count of 2,300/mm 3 (2.3 × 10 9 /L).5. Temperature of 101.2°F (38.4°C).
47. Urine specific gravity of 1.020.

Answer 42

42. 2, 4, 5. Chemotherapy causes bone marrow suppression and risk of infection. A platelet count
    of 40,000/mm 3 (40 × 10 9 /L) and a white blood cell count of 2,300/mm 3 (2.3 × 10 9 /L) are low. A
    temperature of 101.2°F (38.4°C) is high and could indicate an infection. Further assessment and
    examination should be performed to rule out infection. The BUN, hemoglobin, and specific gravity
    values are normal.
    CN: Reduction of risk potential; CL: Analyze

Question 43

43. A nurse is checking the laboratory results of a client with colon cancer admitted for further
    chemotherapy. The client has lost 30 lb (13.6 kg) since initiation of the treatment. Which laboratory
    result should be reported to the health care provider?
44. Blood glucose level of 95 mg/dL (5.3 mmol/L).
45. Total cholesterol level of 182 mg/dL (10.1 mmol/L).
46. Hemoglobin level of 12.3 mg/dL (123 g/L).
47. Albumin level of 2.8 g/dL (28 g/L).

Answer 43

43. 4. The nurse must recognize that an albumin level of 2.8 g/dL (28 g/L) indicates catabolism
       and potential for malnutrition. Normal albumin is 3.5 to 5.0 g/dL (35 to 50 g/L); less than 3.5 (35 g/L)
       indicates malnutrition. The other laboratory results are normal.
       CN: Reduction of risk potential; CL: Analyze

Question 44

44. Which of the following is the most reliable early indicator of infection in a client who is
neutropenic?
1. Fever.
2. Chills.
3. Tachycardia.
4. Dyspnea.

Answer 44

44. 1. Fever is an early sign requiring clinical intervention to identify potential causes. Chills and
       dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical
       situations when associated with infection; it usually occurs in response to an elevated temperature or
       change in cardiac function.
       CN: Reduction of risk potential; CL: Analyze

Question 45

45. A nurse is caring for a client who is undergoing chemotherapy. Current laboratory values are
    noted on the chart. Which action would be most appropriate for the nurse to implement?

LABORATORY RESULTS
HEMOGLOBIN 12.0 G/DL
PLATELET COUNT 108,000/MM3
WBC COUNT 1,600 / MM3
ANC <1,000 /MM3

1. Wearing a protective gown and particulate respiratory mask when completing treatments.
2. Washing hands before and after entering the room.
3. Restricting visitors.
4. Contacting the physician for a prescription for hematopoietic factors such as erythropoietin.

Answer 45

45. 2. Chemotherapy causes myelosuppression with a decrease in red blood cells (RBCs),
       WBCs, and platelets. This client’s data demonstrate neutropenia, placing the client at risk forinfection. An ANC of 500 to 1,000/mm 3 (0.5 to 1 × 10 9 /L) indicates a moderate risk of infection; less
       than 500/mm 3 (0.5 × 10 9 /L) indicates severe neutropenia and a high risk of infection. When the WBC
       count is low and immature WBCs are present, normal phagocytosis is impaired. Precautions to
       protect the client from life-threatening infections may be instituted when ANC is less than 1,000/mm 3
       (1 × 10 9 /L). Hand washing is the best way to avoid the spread of infection. It is not necessary to wear
       a gown and mask to take care of this client. It is also not necessary to restrict visitors; however,
       visitors should be screened to avoid exposing the client to possible infections. Erythropoietin is used
       for stimulating RBCs, not WBCs. Granulocyte colony-stimulating factors or granulocyte macrophage
       colony-stimulating factors are useful for treating neutropenia.
       CN: Safety and infection control; CL: Synthesize

Question 46

46. A client is using a herbal therapy while receiving chemotherapy. The nurse should:
47. Determine what substances the client is using, and make sure that the physician is aware of all
    therapies the client is using.
48. Guide the client in the decision-making process to select either Western or alternative
    medicine.
49. Encourage the client to seek alternative modalities that do not require the ingestion of
    substances.
50. Recommend that the client stop using the alternative medicines immediately.

Answer 46

46. 1. The role of the nurse is to assess what substances or medications the client is using and to
       document and inform other members of the health care team. It is very important to encourage the
       client to keep the physician informed of all therapeutic agents, medications, and supplements she is
       using, to avoid adverse interactions. It is not appropriate for the nurse to suggest that the client choose
       either Western or alternative therapies or to discourage the client’s use of alternative therapies. The
       nurse should remain objective about the client’s treatment choices and respect her autonomy.
       CN: Reduction of risk potential; CL: Synthesize

Question 47

47. A client diagnosed with cancer is receiving chemotherapy. The nurses should assess which of
    the following diagnostic values while the client is receiving chemotherapy?1. Bone marrow cells.
48. Liver tissues.
49. Heart tissues.
50. Pancreatic enzymes.

Answer 47

47. 1. The fast-growing, normal cells most likely to be affected by certain cancer treatments are
       blood-forming cells in the bone marrow, as well as cells in the digestive track, reproductive system,
       and hair follicles. Fortunately, most normal cells recover quickly when treatment is over. Bone
       marrow suppression (a decreased ability of the bone marrow to manufacture blood cells) is a
       common side effect of chemotherapy. A low white blood cell count (neutropenia) increasing the risk
       of infection during chemotherapy, but other blood cells made in the bone marrow can be affected as
       well. Most cancer agents do not affect tissues and organs, such as heart, liver, and pancreas.
       CN: Physiologic adaptation; CL: Apply

Question 48

48. A client is receiving chemotherapy that has the potential to cause pulmonary toxicity. Which
    of the following symptoms indicates a toxic response to the chemotherapy?
49. Decrease in appetite.
50. Drowsiness.
51. Spasms of the diaphragm.
52. Cough and shortness of breath.

Answer 48

48. 4. Cough and shortness of breath are significant symptoms because they may indicate
       decreasing pulmonary function secondary to drug toxicity. Decrease in appetite, difficulty in thinking
       clearly, and spasms of the diaphragm may occur as a result of chemotherapy; however, they are not
       indicative of pulmonary toxicity.
       CN: Physiological adaptation; CL: Evaluate

Question 49

49. A client is to start chemotherapy to treat lung cancer. A venous access device has been placed
    to administration of chemotherapeutic medications. Three days later at the scheduled appointment to
    receive chemotherapy, the nurse assesses that the client is dyspneic and the skin is warm and pale.
    The vital signs are BP 80/30, P 132, R 28, T 103°F (39.4°C), and oxygen saturation 84%. The central
    line insertion site is inflamed. After calling the rapid response team, what should the nurse do next?
50. Place cold, wet compresses on the client’s head.
51. Obtain a portable ECG monitor.
52. Administer a prescribed antipyretic.
53. Insert a peripheral intravenous fluid line and infuse normal saline.

Answer 49

49. 4. The client is experiencing severe sepsis, and it is essential to increase circulating fluid
       volume to restore the blood pressure and cardiac output. The wet compress, administering the
       antipyretic, and monitoring the client’s cardiac status may be beneficial for this client, but they are not
       the highest priority action at this time. These three interventions may require the nurse to leave the
       client, which is not advisable at this time.
       CN: Physiological adaptation; CL: Synthesize

Question 50

The Client Who Is Receiving Radiation Therapy
50. A client is beginning external beam radiation therapy to the right axilla after a lumpectomy for
breast cancer. Which of the following should the nurse include in client teaching?
1. Use a heating pad under the right arm.
2. Immobilize the right arm.
3. Place ice on the area after each treatment.
4. Apply deodorant only under the left arm.

Answer 50

The Client Who Is Receiving Radiation Therapy
50. 4. The nurse should instruct the client to avoid using chemicals such as a deodorant and hot or
cold, or applications such as a heating pad or ice pack to the area being treated. The client should be
encouraged to use the extremity to prevent muscle atrophy and contractures.CN: Health promotion and maintenance; CL: Synthesize

Question 51

51. A client receiving radiation therapy for lung cancer is having difficulty sleeping. The nurse
    should:
52. Suggest the client stop watching television before bed.
53. Assess the client’s usual sleep patterns, amount of sleep, and bedtime rituals.
54. Tell the client sleeplessness is expected with radiation therapy.
55. Suggest that the client stop drinking coffee until the therapy is completed.

Answer 51

51. 2. The nurse should first assess the client’s usual sleep patterns, hours of sleep required
       before treatment, and usual bedtime routine. Refraining from watching television before bedtime and
       avoiding caffeine intake are reasonable suggestions and sleeplessness is an adverse effect of
       radiation therapy. However, assessment is required before any of these options should be suggested.
       CN: Health promotion and maintenance; CL: Synthesize

Question 52

52. A 56-year-old female client is currently receiving radiation therapy to the chest wall for
    recurrent breast cancer. She has pain while swallowing and burning and tightness in her chest. The
    nurse should further assess the client for indications of:
53. Hiatal hernia.
54. Stomatitis.
55. Radiation enteritis.
56. Esophagitis.

Answer 52

52. 4. Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a
       common complication of radiation therapy of the chest wall. Hiatal hernia is a herniation of a portion
       of the stomach into the esophagus. The client could experience burning and tightness in the chest
       secondary to a hiatal hernia, but not pain when swallowing. Also, hiatal hernia is not a complication
       of radiation therapy. Stomatitis is an inflammation of the oral cavity characterized by pain, burning,
       and ulcerations. The client with stomatitis may experience pain with swallowing, but not burning and
       tightness in the chest. Radiation enteritis is a disorder of the large and small bowel that occurs during
       or after radiation therapy to the abdomen, pelvis, or rectum. Nausea, vomiting, abdominal cramping,
       the frequent urge to have a bowel movement, and watery diarrhea are the signs and symptoms.
       CN: Physiological adaptation; CL: Analyze

Question 53

53. A 36-year-old female is scheduled to receive external radiation therapy and a cesium implant
    for cancer of the cervix. Which of the following statements would be most accurate to include in the
    teaching plan about the potential effects of radiation therapy on sexuality?
54. “You can have sexual intercourse while the implant is in place.”
55. “You may notice some vaginal dryness after treatment is completed.”
56. “You may notice some vaginal relaxation after treatment is completed.”
57. “You will continue to have normal menstrual periods during treatment.”

Answer 53

53. 2. Radiation fields that include the ovaries usually result in premature menopause. Vaginal
       dryness will occur without estrogen replacement. There should be no sexual intercourse while the
       implant is in place. Cesium is a radioactive isotope used for therapeutic irradiation of cancerous
       tissue. There is no documentation to support vaginal relaxation after treatment. Because the client will
       have premature menopause, she will not have normal menstrual periods.
       CN: Physiological adaptation; CL: Synthesize

Question 54

54. The nurse caring for a client who is receiving external beam radiation therapy for treatment
    of lung cancer should assess the client for which of the following?
55. Diarrhea.
56. Improved energy level.
57. Dysphagia.
58. Normal white blood cell count.

Answer 54

54. 3. Radiation-induced esophagitis with dysphagia is particularly common in clients who
       receive radiation to the chest. The anatomic location of the esophagus is posterior to the mediastinum
       and is within the field of primary treatment. Diarrhea may occur with radiation to the abdomen.
       Decreased energy level and decreased white blood cell count are potential complications of radiation
       therapy.
       CN: Reduction of risk potential; CL: Analyze

Question 55

The Client Who Requires Symptom Management
55. A client receiving radiation to the head and neck is experiencing stomatitis. The nurse should
recommend:
1. Evaluation by a dentist.
2. Alcohol-based mouth wash rinses.
3. Artificial saliva.
4. Vigorous brushing of teeth after each meal.

Answer 55

The Client Who Requires Symptom Management
55. 3. Head and neck radiation can cause the complication of stomatitis and decreased salivary
flow. A saliva substitute will assist with dryness, moistening food, and swallowing. Meticulous
mouth care is needed; however, alcohol and vigorous brushing will increase irritation. Evaluation by
a dentist to perform necessary dental work is done prior to initiation of therapy.
CN: Physiological adaptation; CL: Synthesize

Question 56

56. A client undergoing chemotherapy has a white blood cell count of 2,300/mm 3 (2.3 × 10 9 /L),
    hemoglobin of 9.8 g/dL (98 g/L), platelet count of 80,000/mm 3 (80 × 10 9 /L), and potassium of 3.8.
    Which of the following should take priority?
57. Blood pressure 136/88.
58. Emesis of 90 mL.
59. Temperature 101°F (38.3°C).
60. Urine output 40 mL/h.

Answer 56

56. 3. The client has a low white blood cell count from the chemotherapy and has a temperature.
       Signs and symptoms of infection may be diminished in a client receiving chemotherapy; therefore, the
       temperature elevation is significant. Early detection of the source of infection facilitates early
       intervention. Surveillance for bleeding is important with the low hemoglobin and platelet count;
       however, the high blood pressure does not indicate bleeding. Vomiting is a side effect of
       chemotherapy and should be treated. The urine output and potassium are within normal limits.CN: Physiological adaptation; CL: Synthesize

Question 57

57. A client with bladder cancer has lost an estimated 500 mL blood in the urine. The client’s
    hemoglobin is 8.0 g/dL (80 g/L), and the physician prescribes a unit of packed blood cells. To
    administer the packed red blood cells, the nurse should:
58. Attach the packed cells to the existing 19G IV of normal saline solution using Y tubing.
59. Start an additional 22G IV site because the packed blood cells must be given in a separate
    line.
60. Attach the packed blood cells to the existing 22G IV of 5% dextrose using Y tubing.
61. Start an additional IV access device with a 22G Intracath.

Answer 57

57. 1. The packed cells should be administered using a central catheter or 19G needle. Y tubing is
       used and the normal saline solution is used to keep the vein open when the blood transfusion is
       complete. Blood is not compatible with dextrose because dextrose may cause blood coagulation.
       Blood products should be given with normal saline solution. A blood filter must be used for all blood
       products to filter out sediment from stored blood products. It is not necessary to add another IV
       access.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 58

58. A nurse is caring for a client 24 hours after an abdominal-perineal resection for a bowel
    tumor. The client’s wife asks if she can bring him some of his favorite home-cooked Italian
    minestrone soup. The nurse should first?
59. Auscultate for bowel sounds.
60. Ask the client if he feels hunger or gas pains.
61. Consult the dietician.
62. Encourage the wife to bring the soup.

Answer 58

58. 1. The nurse should perform a thorough assessment of the abdomen and auscultate for bowel
       sounds in all four quadrants. Clients who have gastrointestinal surgery may have decreased
       peristalsis for several days after surgery. The nurse should check the abdomen for distention and
       check with the client and the medical record regarding the passage of flatus or stool. Consulting a
       dietician would be inappropriate because the client must be kept on nothing-by-mouth status until
       bowel sounds are present. The nurse should explain to the wife that it is too soon after surgery for her
       husband to eat.
       CN: Reduction of risk potential; CL: Synthesize

Question 59

59. A nurse is making follow-up phone calls to clients being treated for cancer. In which order of
    priority should the nurse return the calls?
60. The client receiving chemotherapy who has a loss of appetite.
61. The client who underwent a mastectomy 2 weeks ago who called for information on the Reach
    for Recovery program.
62. The client receiving spinal radiation for bone cancer metastases who has urinary incontinence.4. The client with colon cancer who has questions about a high-fiber diet.

Answer 59

59.
3. The client receiving spinal radiation for bone cancer metastases who has urinary incontinence.
1. The client receiving chemotherapy who has a loss of appetite.
4. The client with colon cancer who has questions about a high-fiber diet.
2. The client who underwent a mastectomy 2 weeks ago who called for information on the Reach
for Recovery program.
Using Maslow’s hierarchy of needs to set priorities, the nurse should first call the client with bone
cancer metastases to the spine because this client is at risk for compression, damage, or severing of
the spinal cord. The nurse should evaluate the client immediately for urinary incontinence, paralysis,
difficulty ambulating, and possible weakness or loss of motor function. The nurse should next call the
client with loss of appetite to assess weight loss and suggest ways to increase the appetite. The client
with colon cancer requires assistance with diet planning, also a physiologic need, but this client is not
at high risk for weight loss. Lastly, the nurse should obtain information on Reach to Recovery and
return the call to the client with a mastectomy. The needs of this client are the least urgent.
CN: Reduction of risk potential; CL: Synthesize

Question 60

60. Which of the following nursing interventions would be most helpful in improving the
    respiratory effort of a client with metastatic lung cancer?
61. Teaching the client diaphragmatic breathing techniques.
62. Administering cough suppressants as prescribed.
63. Teaching and encouraging pursed-lip breathing.
64. Placing the client in a low semi-Fowler’s position.

Answer 60

60. 3. For clients with obstructive versus restrictive disorders, extending exhalation through
       pursed-lip breathing will make the respiratory effort more efficient. The usual position of choice for
       this client is the upright position, leaning slightly forward to allow greater lung expansion. Teaching
       diaphragmatic breathing techniques will be more helpful to the client with a restrictive disorder.Administering cough suppressants will not help respiratory effort. A low semi-Fowler’s position does
       not encourage lung expansion. Lung expansion is enhanced in the upright position.
       CN: Basic care and comfort; CL: Synthesize

Question 61

61. Which of the following should be included in the teaching plan for a client with cancer who
    is experiencing thrombocytopenia? Select all that apply.
62. Use an electric razor.
63. Use a soft-bristle toothbrush.
64. Avoid frequent flossing for oral care.
65. Include an over-the-counter nonsteroidal anti-inflammatory (NSAID) daily for pain control.
66. Monitor temperature daily.
67. Report bleeding, such as nosebleed, petechiae, or melena, to a health care professional.

Answer 61

61. 1, 2, 3, 6. Thrombocytopenia places the client at risk for bleeding. Therefore, electric razors
    will reduce the potential for skin nicks and bleeding. Oral hygiene should be provided with a soft
    toothbrush and with minimal friction to gently clean without trauma. Clients should be instructed to
    read labels on all over-the-counter medications and avoid medications such as aspirin or NSAIDs
    due to their effect on platelet adhesiveness. Clients should evaluate mucous membranes, skin, stools,
    or other sources of potential bleeding. Monitoring temperature may be an important part of
    assessment but is focused on neutropenia instead of the problem of thrombocytopenia.
    CN: Reduction of risk potential; CL: Create

Question 62

62. A client with cancer is afraid of experiencing a febrile reaction associated with blood
    transfusions. The nurse should explain to the client that:
63. “Febrile reactions are caused when antibodies on the surface of blood cells in the transfusion
    are directed against antigens of the recipient.”
64. “Febrile reactions can usually be prevented by administering antipyretics and antihistamines
    before the start of the transfusion.”
65. “Febrile reactions are rarely immune-mediated reactions and can be a sign of hemolytic
    transfusion.”
66. “Febrile reactions primarily occur within 15 minutes after initiation of the transfusion and can
    occur during the blood transfusion.”

Answer 62

62. 2. The administration of antipyretics and antihistamines before initiation of the transfusion in
       the frequently transfused client can decrease the incidence of febrile reactions. Febrile reactions are
       immune-mediated and are caused by antibodies in the recipient that are directed against antigens
       present on the granulocytes, platelets, and lymphocytes in the transfused component. They are the most
       common transfusion reactions and may occur with onset, during transfusion, or hours after transfusion
       is completed.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 63

63. An adult who recently had a right pneumonectomy for lung cancer is admitted to the oncology
    unit with dyspnea and fever. The nurse should:
64. Place the client on the left side.
65. Position the client for postural drainage.
66. Provide education on deep-breathing exercises.
67. Instruct the client to maintain bed rest with bathroom privileges.

Answer 63

63. 3. The fever and dyspnea suggest a respiratory infection. Education on deep-breathing
       exercises or incentive spirometry, elevating the head of the bed, and getting out of bed to a chair is
       necessary to promote lung expansion. When in bed, positioning the client with good lung down should
       be avoided, since this impedes expansion of the only lung. Postural drainage positioning will lower
       the head of bed and increase dyspnea.
       CN: Physiological adaptation; CL: Synthesize

Question 64

64. A client undergoing chemotherapy tells the nurse, “I do not want to get out of bed in the
    morning because I am so tired.” The nursing plan of care should include:
65. Education on the use of filgrastim.
66. Individually tailored exercise program.3. Weight lifting when not experiencing fatigue.
67. Bed rest until chemotherapy is completed.

Answer 64

64. 2. An individualized exercise program will increase stamina and endurance. Weight lifting
       may be too vigorous. Filgrastim is used to increase white blood cells and is not applicable in this
       situation. Decreased hemoglobin and hematocrit predisposes the client to fatigue due to decreased
       oxygen availability. Bed rest causes muscle atrophy, adding to fatigue, and promotes DVT formation.
       CN: Health promotion and maintenance; CL: Synthesize

Question 65

65. A nurse is reviewing the chart of an adult male with cancer. The health care provider has
    prescribed filgrastim 400 mcg, subcutaneously once daily. The nurse reviews the laboratory report
    and determines treatment has been effective when:

HEMOGLOBIN 16G/DL
WBC COUNT: 3,500/MM3
PLATELET COUNT : 200,000/MM3
RED BLOOD CELL COUNT: 4.3 M / MM3

1. Hemoglobin is 16 g/dL (160 g/L).
2. WBC count is 3,500/mm 3 (3.5 × 10 9 /L).
3. Platelet count is 200,000/mm 3 (200 × 10 9 /L).
4. RBC count is 4.3 million/mm 3 (4.3 × 10 12 /L).

Answer 65

65. 1. Chemotherapy may cause suppression of the immune system, resulting in a reduction in the
       WBC count and placing the client at risk for infection. Decreased hemoglobin (Hgb) indicates
       anemia. The Hgb is within normal limits for an adult male. A decreased platelet count would indicate
       thrombocytopenia, and platelets would be prescribed. The platelet count is within normal limits for
       an adult male. Epoetin alfa is used to treat low red blood cell counts (anemia) caused by
       chemotherapy.
       CN: Pharmacologic and parenteral therapy; CL: Evaluate

Question 66

66. The nurse is teaching the client who is receiving chemotherapy and the family how to manage
    possible nausea and vomiting at home. The nurse should include information about:
67. Eating frequent, small meals throughout the day.
68. Eating three normal meals a day.
69. Eating only cold foods with no odor.
70. Limiting the amount of fluid intake.

Answer 66

66. 1. Dietary suggestions to reduce adverse effects of cancer and cancer therapies include a soft,
       bland diet low in fat and sugar. Frequent, small meals are usually better tolerated. It is not necessary
       to restrict the diet to cold foods. Fluid intake should be encouraged to avoid dehydration.
       CN: Basic care and comfort; CL: Synthesize

Question 67

67. A terminally ill client in hospice care is experiencing nausea and vomiting because of a
    partial bowel obstruction. To respect the client’s wishes for conservative management of the nausea
    and vomiting, the nurse should recommend the use of:
68. A nasogastric (NG) suction tube.
69. IV antiemetics.
70. Osmotic laxatives.
71. A clear liquid diet.

Answer 67

67. 4. The use of diet modification is a conservative approach to treat the terminally ill or hospice
       clients who have nausea and vomiting related to bowel obstruction. Osmotic laxatives would be
       harder for the client to tolerate. An NG tube is more aggressive and invasive. IV antiemetics are also
       invasive. The hospice philosophy involves comfort and palliative care for the terminally ill.
       CN: Basic care and comfort; CL: Synthesize

Question 68

68. An adult is dying from metastatic lung cancer, and all treatments have been discontinued. The
    client’s breathing pattern is labored, with gurgling sounds. The client’s spouse asks the nurse, “Can’t
    you do something to help with the breathing?” Which of the following is the nurse’s best response in
    this situation?
69. Direct the unlicensed personnel to assess the client’s vital signs and provide oral care.
70. Suction the client so that the client’s spouse knows all interventions were performed.
71. Reposition the client, elevate the head of the bed, and provide a cool compress.
72. Explain to the spouse that it is standard practice not to suction clients when treatments have
    been discontinued.

Answer 68

68. 3. Repositioning the client, elevating the head of the bed, and providing a cool compress are
       comfort interventions consistent with the concept of palliative care of the dying. Directing the
       unlicensed personnel to assess vital signs focuses on the dying process, not the client. Suctioning may
       not benefit the client and is considered invasive and uncomfortable. Telling the spouse an intervention
       is not needed discounts the spouse’s judgment and concerns.
       CN: Basic care and comfort; CL: Synthesize

Question 69

69. A client is concerned about losing the hair on the head as a result of chemotherapy. Which of
    the following responses from the nurse will be most helpful to the client?1. “The new growth of hair will be gray.”
70. “The hair loss is temporary.”
71. “New hair growth will always be the same texture and color as it was before chemotherapy.”
72. “The client should avoid use of wigs when possible.”

Answer 69

69. 2. Alopecia from chemotherapy is temporary. The new hair will not be necessarily gray, but
       the texture and color of new hair growth may be different. Clients who will be receiving
       chemotherapy should be encouraged to purchase a wig while they still have hair so that they can
       match the color and texture of their hair. Loss of hair, or alopecia, is a serious threat to self-esteem
       and should be addressed quickly before treatment.
       CN: Pharmacological and parenteral therapies; CL: Apply

Question 70

70. An adult with a history of chronic obstructive pulmonary disease (COPD) and metastatic
    carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice
    program. The nurse should conduct a focused client assessment for:
71. Ascites.
72. Pleural friction rub.
73. Dyspnea.
74. Peripheral edema.

Answer 70

70. 3. Dyspnea is a distressing symptom in clients with advanced cancer including metastatic
       carcinoma of the lung, previous radiation therapy, and coexisting COPD. Ascites does occur in clients
       with metastatic carcinoma; however, in the client with COPD and lung cancer, dyspnea is a more
       common finding. A pleural friction rub is usually associated with pneumonia, pleurisy, or pulmonary
       infarct.
       CN: Physiological adaptation; CL: Analyze

Question 71

71. The nurse is planning with a client who has cancer to improve the client’s independence in
    activities of daily living after radiation therapy. Which of the following is an appropriate nursing
    intervention?
72. Refer the client to a community support group after discharge from the rehabilitation unit.
73. Make certain that a family member is present for the rehabilitation sessions.
74. Provide positive reinforcement for skills achieved.
75. Inform the client of rehabilitation plans made by the rehabilitation team.

Answer 71

71. 3. The positive reinforcement builds confidence and facilitates achievement of rehabilitation
       goals. Community support may or may not be applicable after discharge. Although family support is
       an important component of rehabilitation, reinforcing the skills the client has acquired is of greater
       importance when regaining independence. Rehabilitation plans should include the client, family, or
       both.
       CN: Psychosocial integrity; CL: Synthesize

Question 72

72. When teaching about prevention of infection to a client with a long-term venous catheter, the
    nurse determines that the client has understood discharge instructions when the client states which of
    the following?
73. “I will not remove the dressing until I return to the clinic next week.”
74. “My husband or I will do the dressing changes three times per week, exactly the way you
    showed us.”
75. “I will monitor my temperature once each weekday.”
76. “I know it is very important to wash my hands after irrigating the catheter.”

Answer 72

72. 2. The most important intervention for infection control is to continue meticulous catheter site
       care. Dressings are to be changed two to three times per week depending on institutional policies.
       Temperature should be monitored at least once a day in someone with a vascular access device. Hand
       washing before and after irrigation or any manipulation of the site is a must for infection prevention.
       CN: Safety and infection control; CL: Evaluate

Question 73

73. When caring for a client with a central venous line, which of the following nursing actions
    should be implemented in the plan of care for chemotherapy administration? Select all that apply.
74. Verify patency of the line by the presence of a blood return at regular intervals.
75. Inspect the insertion site for swelling, erythema, or drainage.
76. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not
    present.
77. If unable to aspirate blood, reposition the client and encourage the client to cough.
78. Contact the health care provider about verifying placement if the status is questionable.

Answer 73

73. 1, 2, 4, 5. A major concern with IV administration of cytotoxic agents is vessel irritation or
    extravasation. The Oncology Nursing Society and hospital guidelines require frequent reevaluation of
    blood return when administering vesicant or nonvesicant chemotherapy due to the risk of
    extravasation. These guidelines apply to peripheral and central venous lines. The nurse should also
    assess the insertion site for signs of infiltration, such as swelling and redness. In addition, central
    venous lines may be long-term venous access devices. Thus, difficulty drawing or aspirating blood
    may indicate the line is against the vessel wall or may indicate the line has occlusion. Having theclient cough or move position may change the status of the line if it is temporarily against a vessel
    wall. Occlusion warrants more thorough evaluation via x-ray study to verify placement if the status is
    questionable and may require a declotting regimen (Abbokinase). The nurse should not administer any
    drug if the IV line is not open or does not have an adequate blood return.
    CN: Pharmacological and parenteral therapies; CL: Create

Question 74

74. Indicate on the illustration the area that correctly identifies the position of the distal tip of a
    central line that is inserted into the subclavian vessel.

Answer 74

74. The distal tip of a central line lies in the superior vena cava or right atrium.
    CN: Pharmacological and parenteral therapies; CL: Apply

Question 75

75. A client with pancreatic cancer, who has been bed-bound for 3 weeks, has just returned from
    having a left subclavian, long-term, tunneled catheter inserted for administration of analgesics. The
    nurse has not yet received radiographic results for confirmation of placement. The client becomes
    restless and dyspneic and has chest pain radiating to the middle of the back. Physical assessment
    reveals tachycardia and absent breath sounds in the left lung. The nurse should further assess the
    client for:
76. An air embolus.
77. A pneumothorax.
78. A pulmonary embolus.
79. A myocardial infarction.

Answer 75

75. 2. The client is exhibiting signs and symptoms of a pneumothorax from the insertion of the
       subclavian venous catheter. Although it is possible that the client suffered an air embolus during the
       procedure, and the client is at risk for pulmonary emboli because of his immobility, absent breath
       sounds immediately after insertion of a subclavian line are strongly suggestive of a pneumothorax.
       Unilateral absent breath sounds are not associated with a myocardial infarction.
       CN: Physiological adaptation; CL: Analyze

Question 76

76. In setting goals for a client with advanced liver cancer who has poor nutrition, the nurse
    determines that which of the following is a desired outcome for the client? The client will:
77. Have normalized albumin levels.
78. Return to ideal body weight.
79. Gain 1 lb (0.45 kg) every 2 weeks.
80. Maintain current weight.

Answer 76

76. 4. An appropriate and realistic outcome would be for the client to maintain current weight or
       not lose weight. It is unrealistic to expect that the client with advanced liver cancer will have normal
       albumin levels or will be able to gain weight.
       CN: Basic care and comfort; CL: Synthesize

Question 77

77. The nurse administers a bolus tube feeding to a client with cancer. Which of the following
    nursing interventions is most appropriate to decrease the risk of aspiration?
78. Place the client on bed rest with the head of the bed elevated to 60 degrees for 2 hours.
79. Place the client on the left side with the head of the bed at 45 degrees for 15 minutes.
80. Assist the client out of bed to sit upright in a chair for 1 hour.
81. Ask the client to rest in bed with the head of the bed elevated to 30 degrees for 20 minutes.

Answer 77

77. 3. As long as the client is able to get out of bed, the preferred position and time frame for
       preventing aspiration after a bolus tube feeding is sitting upright out of bed in a chair for 30 to 60
       minutes. Placing the client on the right, not the left, side may facilitate gastric emptying, but this is not
       the preferred position. Elevating the bed 30 degrees decreases the risk of aspiration, but this
       elevation must be maintained for at least 45 to 60 minutes.
       CN: Basic care and comfort; CL: Synthesize

Question 78

78. A client with colon cancer had a left hemicolectomy 3 weeks ago. The client is still having
    difficulty maintaining an adequate oral intake to meet metabolic needs for optimal healing. Which of
    the following nutritional supports would be most appropriate?
79. Total parenteral nutrition through a central catheter.
80. IV infusion of dextrose.
81. Nasogastric feeding tube with protein supplement.
82. Jejunostomy for high caloric feedings.

Answer 78

78. 1. Total parenteral nutrition solutions supply the body with sufficient amounts of dextrose,
       amino acids, fats, vitamins, and minerals to meet metabolic needs. Clients who are unable to tolerate
       adequate quantities of foods and fluids and those who have had extensive bowel surgery may not becandidates for enteral feedings. The nurse would anticipate total parenteral nutrition via central
       catheter to promote wound healing. IV dextrose does not supply all the nutrients required to promote
       wound healing.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 79

79. A client with colon cancer undergoes surgical removal of a segment of colon and creation of
    a sigmoid colostomy. What assessments by the nurse indicate the client is developing complications
    within the first 24 hours? Select all that apply.
80. Coarse breath sounds auscultated bilaterally at the bases.
81. Dusky appearance of the stoma.
82. No drainage in the ostomy appliance.
83. Temperature greater than 101.2°F (38.5°C).
84. Decreased bowel sounds

Answer 79

79. 1, 2, 4. Elevated temperature in the first 24 hours along with coarse breath sounds may
    indicate a respiratory complication or the result of general anesthesia. Use of incentive spirometry
    and increasing activity would be key interventions. A healthy stoma will be beefy red. A dusky
    appearance of the stoma indicates decreased blood supply and is of concern. It is not uncommon to
    have decreased bowel sounds initially after gastrointestinal surgery. In addition, it usually will take
    time for the ostomy to function.
    CN: Reduction of risk potential; CL: Analyze

Question 80

80. A client receiving chemotherapy for metastatic colon cancer is admitted to the hospital
    because of prolonged vomiting. Assessment findings include irregular pulse of 120, blood pressure
    88/48, respiratory rate of 14, serum potassium of 2.9 mEq/L (2.9 mmol/L), and arterial blood gas—
    pH 7.46, PCO 2 45 (6 kPA), PO 2 95 (12.6 kPa), bicarbonate level 29 mEq/L (29 mmol/L). The nurse
    should implement which of the following prescriptions first?
81. Oxygen at 4 L per nasal cannula.
82. Repeat lab work in 4 hours.
83. 5% dextrose in 0.45% normal saline with KCl 40 mEq/L at 125 mL/h.
84. 12 lead EKG.

Answer 80

80. 3. The vital signs suggest that the client is dehydrated from the vomiting, and the nurse should
       first infuse the IV fluids with the addition of potassium. There is no indication that the client needs
       oxygen at this time since the PO 2 is 95 (12.6 kPa). Although the client has a rapid and irregular pulse,
       the infusion of fluids may cause the heart rate to return to normal, and the 12 lead EKG can be
       prescribed after starting the intravenous fluids.
       CN: Physiological adaptation; CL: Synthesize

Question 81

81. One week after a left mastectomy, the client reports her appetite is still not good, she is not
    getting much sleep, and her husband is avoiding her. She is eager to get back to work. Which of the
    following should the nurse do first?
82. Call the physician to discuss allowing the client to return to work earlier.
83. Suggest that the client learn relaxation techniques for help with her insomnia.
84. Perform a nutritional assessment to assess for anorexia.
85. Ask open-ended questions about sexuality issues related to her mastectomy.

Answer 81

81. 4. The content of the client’s comments suggests that she is concerned about her husband
       avoiding her. Addressing sexuality issues is appropriate for a client who has undergone a
       mastectomy. Rushing her return to work may add to her exhaustion. Suggesting that she learn
       relaxation techniques for help with her insomnia is appropriate; however, the nurse must first address
       the psychosocial and sexual issues. A nutritional assessment may be useful, but there is no indication
       that she has anorexia.
       CN: Psychosocial integrity; CL: Synthesize

Question 82

82. Which of the following clients with cancer should the nurse assess first?
83. A 38-year-old woman receiving internal radiation therapy for cervical cancer.
84. A 27-year-old man with leukemia hospitalized for induction of high-dose chemotherapy.
85. A 75-year-old man with metastatic prostate cancer with a pathologic fracture of the femur who
    is in pain.
86. A 23-year-old woman undergoing surgery for placement of a central venous catheter.

Answer 82

82. 3. The nurse should first assess the 75-year-old man with prostate cancer because of the
       client’s age, need for pain management, extended bed rest, and the potential for preexisting nutritional
       deficits. The nurse should plan to spend a focused but short time with the woman receiving internal
       radiation. The client who will receive chemotherapy will require more observation after receiving
       the medication. The nurse can assess the client who will have a central venous catheter after assuring
       the older client is comfortable.
       CN: Management of care; CL: Synthesize

Question 83

83. The nurse is making a follow-up telephone call to a 52-year-old client with lung cancer. The
    client now has a low-grade fever (100.6°F [38.1°C]), nonproductive cough, and increasing fatigue.
    The client completed the radiation therapy to the mass in the right lung and mediastinum 10 weeks ago
    and has a follow-up appointment to see the physician in 2 weeks. The nurse should advise the client:
84. To take two acetaminophen tablets every 4 to 6 hours for 2 days and call the physician if the
    temperature increases to 101°F (38.3°C) or greater.
85. That this is an expected side effect of the radiation therapy and to keep his appointment in 2
    weeks.
86. To contact the physician for an appointment today.
87. To go to the nearest emergency department.

Answer 83

83. 3. The client is exhibiting early symptoms of pulmonary toxicity as a result of the radiation
       therapy. These are not expected adverse effects of radiation. The client should be examined to
       differentiate between an infection and radiation pneumonitis. Suggesting that the client take
       acetaminophen and call back in 2 days is inappropriate. These signs and symptoms are not indicative
       of a true emergency, but the client should be seen by a health care provider before the next
       appointment.
       CN: Reduction of risk potential; CL: Synthesize

Question 84

84. A client with malignant pleural effusions has dyspnea and chest pain. The nurse should do
    which of the following in order of priority.1. Administer morphine sulfate 2 mg IV.
85. Apply oxygen at 2 L via nasal cannula.
86. Educate the client in anticipation of a thoracentesis.
87. Coach the client on deep-breathing exercise.

Answer 84

84.2. Apply oxygen at 2 L via nasal cannula.
1. Administer morphine sulfate 2 mg IV.
4. Coach the client on deep breathing exercise.
3. Educate the client in anticipation of a thoracentesis.
The client is short of breath. The head of the bed should be elevated to enable breathing and
oxygen should be applied. Morphine should be administered for pain prior to initiating deep
breathing exercises. Deep-breathing exercises improve lung expansion and decrease dyspnea.
Education can be provided on the thoracentesis that is anticipated once the symptoms are managed.
CN: Physiological adaptation; CL: Synthesize

Question 85

85. What instructions should the nurse provide to a client who develops cellulitis in the right arm
    after a right modified radical mastectomy?
86. Antibiotics will need to be taken for 1 to 2 weeks.
87. Arm exercises will get rid of the cellulitis.
88. Ice pack should be applied to the affected area for 20-minute periods to reduce swelling.
89. The right extremity should be lowered to improve blood flow to the forearm.

Answer 85

85. 1. Treatment for cellulitis includes oral or intravenous antibiotics for 1 to 2 weeks, elevation
       of the affected extremity, and application of warm, moist packs to the site. Arm exercises help to
       reduce swelling, but do not treat the infection.
       CN: Physiological adaptation; CL: Synthesize

Question 86

86. An adult has just had a sclerosing agent instilled after chest tube drainage of a pleural
    effusion. The nurse should instruct the client to:
87. Lie still to prevent a pneumothorax.
88. Sit upright with arms on an overhead table to promote lung expansion.
89. Change position frequently to distribute the agent.
90. Lie on the side where the thoracentesis was done to hold pressure on the chest tube site.

Answer 86

86. 3. Changing positions frequently aids in distributing the agent to the pleura for sealing. The
       majority of the pleural fluid is drained, and the lung should already be re-expanded before instillation
       of the sclerosing agent. A pressure dressing is applied to the chest tube exit site, and it is not
       necessary to lie on that side to hold pressure on the area.
       CN: Reduction of risk potential; CL: Synthesize

Question 87

87. After surgery for head and neck cancer, a client has a permanent tracheostomy. The nurse
    should teach the client and family about the importance of:
88. Providing tracheostomy site care.
89. Addressing the psychosocial issues related to tracheostomy.
90. Observing for early signs and symptoms of skin breakdown around the tracheostomy site.
91. Using humidifiers to prevent thick, tenacious secretions.

Answer 87

87. 4. Providing adequate humidification for the client with a tracheostomy is essential. The client
       no longer has the functions of the nose for warming, moistening, or filtering the air when breathing
       through the tracheostomy site. Providing tracheostomy site care, addressing the psychosocial issues,
       and observing for early signs and symptoms of skin breakdown around the tracheostomy site are also
       important; however, using humidifiers to prevent thick, tenacious secretions is the most important
       recommendation for long-term management and the prevention of pulmonary infection.
       CN: Reduction of risk potential; CL: Synthesize

Question 88

88. A client has malignant pleural effusions. The nurse should conduct a focused assessment to
determine if the client has which of the following? Select all that apply.
1. Hiccups.
2. Weight gain.
3. Peripheral edema.
4. Chest pain.
5. Dyspnea.
6. Cough.

Answer 88

88. 4, 5. A malignant pleural effusion is an accumulation of excessive fluid within the pleural
    space that occurs when cancer cells irritate the pleural membrane. Dyspnea can result from the
    increased pressure that may contribute to increased anxiety and fear of suffocation. Pain is a
    consequence of the pleural irritation. Cough is related to the atelectasis of the bronchi and inability to
    clear the airways. Hiccups are usually associated with pericardial effusions. Weight gain and
    peripheral edema may occur with peritoneal effusion.
    CN: Physiological adaptation; CL: Analyze

Question 89

89. A client with lung cancer is undergoing a thoracentesis. Which of the following outcomes of
    the procedure are expected? Select all that apply.
90. Treatment of recurrent malignant effusion.
91. Diagnosis of underlying disease.
92. Palliation of symptoms.
93. Relief of acute respiratory distress.
94. Removal of the cancer cells.

Answer 89

89. 2, 3, 4. Thoracentesis is usually successful for diagnosis of underlying disease, palliation of
    symptoms, and treating the acute respiratory distress; alleviation of the symptoms and distress is
    usually short term. The thoracentesis is not used as a treatment for recurrent pleural effusion becausethe fluid accumulates rapidly. Thoracentesis does not remove cancer cells.
    CN: Reduction of risk potential; CL: Evaluate

Question 90

90. The nurse is assessing a client with anemia. In order to plan nursing care, the nurse should
    focus the assessment on which of the following?
91. Decreased salivation.
92. Bradycardia.
93. Cold intolerance.
94. Nausea.

Answer 90

90. 3. Cold intolerance may be associated with anemia because of the diminished oxygen supply
       to the peripheral circulation. Decreased salivation is not necessarily associated with anemia.
       Tachycardia may be expected in severe anemia. Clients with anemia are usually not nauseated.
       CN: Physiological adaptation; CL: Analyze

Question 91

91. A nurse is assessing an adult who has been receiving chemotherapy. The client has a platelet
    count of 22,000 cells/mm 3 (22 × 10 9 /L) and has petechiae on the lower extremities. The nurse should
    advise the client to:
92. Increase the amount of iron in the client’s diet.
93. Apply lotion to the lower extremities.
94. Elevate the legs.
95. Consult the oncologist.

Answer 91

91. 4. Petechiae are tiny, purplish, hemorrhagic spots visible under the skin. Petechiae usually
       appear when platelets are depleted. Bleeding gums or oozing of blood may accompany the petechiae,
       and the client should seek medical assistance immediately. Increasing iron in the diet will not
       improve the platelet count. Lotion will not treat the petechiae. Elevating the legs will not cause the
       petechiae to disappear.
       CN: Physiological adaptation; CL: Synthesize

Question 92

92. A nurse is teaching a 62-year-old female who has had a left modified radical mastectomy
    with axillary node dissection about lymphedema. The nurse should tell the client that lymphedema
    occurs:
93. If all cancer cells are not removed.
94. In older women.
95. At any time after surgery or not at all.
96. Only with radical mastectomy.

Answer 92

92. 3. Lymphedema after breast cancer surgery is the accumulation of lymph tissue in the tissues
       of the upper extremity extending down from the upper arm. It may occur at any time after surgery in
       women of any age. It is caused by the interruption or removal of lymph channels and nodes after
       axillary node dissection. Removal results in less efficient filtration of lymph fluid and a pooling of
       lymph fluid in the tissues on the affected side. Treatments or interventions should be instituted as soon
       as lymphedema is noted to prevent or reduce further progression. Range-of-motion exercises,
       elevation, and avoidance of injury in the affected arm are important when completing client teaching.
       Lymphoma is not caused by failure to remove all cancer cells. Lymphedema can occur after any
       surgery that disrupts lymph flow, not just radical mastectomy.
       CN: Reduction of risk potential; CL: Synthesize

Question 93

93. A 38-year-old female client with a history of breast-conserving surgery, axillary node
    dissection, and radiation therapy reports that her arm is red, warm to touch, and slightly swollen.
    Which of the following actions should the nurse suggest?
94. Apply warm compresses to the affected arm.
95. Elevate the arm on two pillows.
96. See the physician immediately.
97. Schedule an appointment within 2 to 3 weeks.

Answer 93

93. 3. Redness, warmth, and swelling are all signs of infection. Treatment with antibiotics is
       usually indicated. Infection usually increases fluid accumulation and could worsen the lymphedema.
       Warm compresses could also increase fluid accumulation. Elevation will not treat the infection. It is
       critical that the client not delay treatment.
       CN: Reduction of risk potential; CL: Synthesize

Question 94

94. The nurse is assessing a 42-year-old client with cancer who has lost 1 lb (0.45 kg) in 4
    weeks. The client is taking ondansetron for nausea and now has a temperature of 101°F (38.3°C). The
    fever is indicative of:
95. Inadequate nutrition.
96. New resistance to current antiemetic therapy.
97. Expected response to chemotherapy treatment.
98. Infection.

Answer 94

94. 4. Fever is most commonly related to infection. In a neutropenic client, fever frequently
       occurs in the absence of the usual clinical signs and symptoms of infection. Inadequate nutrition or
       antiemetic therapy resistance would not result in fever. Fever is not usually expected with most
       chemotherapy drugs.
       CN: Physiological adaptation; CL: Analyze

Question 95

95. A nurse is assessing a client with lymphoma who reports distress 9 days after chemotherapy.Because of the risk for septic shock, the nurse should assess the client for which cluster of symptoms?
96. Flushing, decreased oxygen saturation, mild hypotension.
97. Low-grade fever, chills, tachycardia.
98. Elevated temperature, oliguria, hypotension.
99. High-grade fever, normal blood pressure, increased respirations

Answer 95

95. 2. Nine days after chemotherapy, it is expected for the client to be immunocompromised. The
       clinical signs and symptoms of shock reflect changes in cardiac function, vascular resistance, cellular
       metabolism, and capillary permeability. Low-grade fever, tachycardia, and chills may be early signs
       of shock. The client with signs and symptoms of impending septic shock may not have decreased
       oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be
       initially normal or increased.
       CN: Pharmacological and parenteral therapies; CL: Analyze

Question 96

96. An appropriate nursing intervention for a client with fatigue related to cancer treatment
    includes teaching the client to:
97. Increase fluid intake.
98. Minimize naps or periods of rest during day.
99. Conserve energy by prioritizing activities.
100. Limit dietary intake of high-fiber foods.

Answer 96

96. 3. Prioritizing physical activities helps to conserve energy, which promotes adaptation tofatigue. The client should learn to take short naps or short rest periods during the day for additional
       energy conversation. Increased fluid intake is important but may interrupt rest periods by causing
       frequent urination. Limiting intake of high-fiber foods can add to constipation, which may be a
       problem because of inactivity in fatigued clients.
       CN: Basic care and comfort; CL: Synthesize

Question 97

97. The most common issue associated with sleep disturbances in the hospitalized client with
cancer is:
1. Social.
2. Nutritional.
3. Cultural.
4. Psychological.

Answer 97

97. 4. Most hospitalized persons are at risk for sleep disturbances. Psychological issues (such as
       anxiety and depression) and pain are related to sleep deprivation. Social, nutritional, and cultural
       issues are not necessarily associated with sleep disturbances.
       CN: Psychosocial integrity; CL: Apply

Question 98

98. Which of the following represents the most appropriate nursing intervention for a
    hospitalized client with pruritus caused by medications used to treat cancer?
99. Administration of antihistamines.
100. Steroids.
101. Silk sheets.
102. Medicated cool baths.

Answer 98

98. 4. Nursing interventions to decrease the discomfort of pruritus include those that prevent
       vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated baths with
       salicylic acid or colloidal oatmeal can be soothing as a temporary relief. The use of antihistamines or
       topical steroids depends on the cause of the pruritus, and these agents should be used with caution.
       Using silk sheets is not a practical intervention for the hospitalized client with pruritus.
       CN: Basic care and comfort; CL: Apply

Question 99

99. A client receiving chemotherapy has pruritus. In order to develop a care plan, the nurse
    should ask if the client has been:
100. Wearing clothes made from 100% cotton.
101. Sleeping in a cool, humidified room.
102. Increasing fluid intake to at least 3,000 mL/day.
103. Taking daily baths with a deodorant soap.

Answer 99

99. 4. Use of deodorant or fragrant soaps is drying to the skin. Cotton clothing gives the least
       irritation to skin. A cool, humidified environment adds to the client’s comfort as well as providing
       hydration for skin comfort. Fluid intake of 3,000 mL/day is recommended for adequate hydration.
       CN: Basic care and comfort; CL: Analyze

Question 100

100. Which of the following variables is most important to assess when determining the impact
     of the cancer diagnosis and treatment modalities on a long-term survivor’s quality of life?
101. Occupation and employability.
102. Functional status.
103. Evidence of disease.
104. Individual values and beliefs.

Answer 100

100. 4. Individuals with cancer have various cultural values and beliefs that help them cope with
        the cancer experience. Quality of life cannot be evaluated solely by quantifiable factors such as
        employability, functional status, or evidence of disease. It must be evaluated by the survivors within
        the context of their subjective and individual values and beliefs.
        CN: Psychosocial integrity; CL: Analyze

Question 101

101. A client with breast cancer has abdominal bloating and cramping with no bowel movement
     for 5 days. She says she usually has a bowel movement every day after her morning coffee. Bowel
     sounds are present in all four quadrants. She received 80 mg of doxorubicin hydrochloride
     (Adriamycin) 10 days ago. The nurse should contact the health care provider to request a prescription
     for which of the following?
102. A Fleet enema to stimulate peristalsis.
103. A soapsuds enema until clear.3. An oral cathartic until the client has a bowel movement; then evaluate the need for daily stool
     softeners.
104. A daily stool softener for constipation and a mild opioid for abdominal discomfort.

Answer 101

101. 3. Constipation lasting 3 days or longer is unusual in this client and warrants immediate
        action. However, because the client had chemotherapy with doxorubicin (Adriamycin) 10 days ago,
        she is susceptible to infection and should avoid rectal medications and treatments. Abdominal
        discomfort secondary to constipation will be relieved after the client has a bowel movement; an
        opioid would contribute to the constipation.
        CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 102

ould do which of the following? Select all that apply.
1. Use sitz baths.
2. Apply zinc oxide ointment to the rectal area after each bowel movement.
3. Apply a skin-barrier dressing daily to the rectal area.
4. Clean the rectal area with unscented soap and water after each bowel movement, rinse well,
and pat dry.
5. Increase fluid intake.

Answer 102

102. 1, 4, 5. The rectal area needs to be cleaned and gently dried after each bowel movement to
     prevent skin breakdown and inhibit growth of bacteria. Sitz baths are appropriate because they
     promote comfort. The client should increase fluid consumption to prevent dehydration. Zinc oxide
     ointment does form a protective skin barrier, but it makes it difficult to thoroughly clean the perirectal
     area of feces and increases the risk of infection, as do skin-barrier dressings.
     CN: Safety and infection control; CL: Synthesize

Question 103

103. Which of the following statements is most accurate regarding the long-term toxic effects of
     cancer treatments on the immune system?
104. Clients with persistent immunologic abnormalities after treatment are at a much greater risk for
     infection than clients with a history of splenectomy.
105. The use of radiation and combination chemotherapy can result in more frequent and more
     severe immune system impairment.
106. Long-term immunologic effects have been studied only in clients with breast and lung cancer.
107. The helper T cells recover more rapidly than the suppressor T cells, which results in positive
     helper cell balance that can last 5 years.

Answer 103

103. 2. Studies of long-term immunologic effects in clients treated for leukemia, Hodgkin’s
        disease, and breast cancer reveal that combination treatments of chemotherapy and radiation can
        cause overall bone marrow suppression, decreased leukocyte counts, and profound
        immunosuppression. Persistent and severe immunologic impairment may follow radiation andchemotherapy (especially multiagent therapy). There is no evidence of greater risk of infection in
        clients with persistent immunologic abnormalities. Suppressor T cells recover more rapidly than the
        helper T cells.
        CN: Pharmacological and parenteral therapies; CL: Apply

Question 104

The Client Who Is Coping with Loss, Grief,
Bereavement, and Spiritual Distress
104. A client is newly diagnosed with cancer and is beginning a treatment plan. Which of the
following nursing interventions will be most effective in helping the client cope?
1. Assume decision making for the client.
2. Encourage strict compliance with all treatment regimens.
3. Inform the client of all possible adverse treatment effects.
4. Identify available resources.

Answer 104

The Client Who Is Coping with Loss, Grief, Bereavement, and
Spiritual Distress
104. 4. Identifying available resources for the client and family represents a respectful effort to
make options available and encourages the client to become involved in treatment decisions.
Assuming decision making for the client may foster dependence. Encouraging strict compliance with
all treatment regimens may increase anxiety and limit the client’s options and treatment choices.
Informing the client of all possible adverse treatment effects may increase anxiety and fear by
focusing on adverse outcomes too soon.
CN: Psychosocial integrity; CL: Synthesize

Question 105

105. A daughter is concerned that her mother is in denial when discussing her diagnosis of breast
     cancer because she sometimes says that breast cancer isn’t that serious and changes the subject. The
     nurse informs the daughter that denial can be a healthy defense mechanism if it is used:
106. To permit her mother to seek unconventional treatments.
107. When making decisions about her care.
108. Alone and not in combination with other defense mechanisms.
109. To allow her mother to continue in her role as a mother.

Answer 105

105. 4. Denial is a defense mechanism used to shut out a situation that is too frightening or
        threatening to tolerate. In this case, denial allows the client to vacillate between acceptance of the
        illness and its treatment and denial of the actual or potential seriousness of the disease. This may
        allow the client more psychological freedom to maintain her current roles in the family and
        elsewhere. Denial can be harmful if the client ignores standard medical therapies in favor of
        unconventional treatments. Denial is not helpful when it interferes with a client’s willingness to seek
        treatment or make decisions about care. Using any one defense mechanism exclusively usually
        reflects maladaptive coping. Other defense mechanisms that may be used include regression, humor,
        and sublimation.
        CN: Psychosocial integrity; CL: Apply

Question 106

106. A 45-year-old single mother of three teenaged boys has metastatic breast cancer. Her
     parents live 750 miles (1,207 km) away and have only been able to visit twice since her initial
     diagnosis 14 months ago. The progression of her disease has forced the client to consider high-dose
     chemotherapy. She is concerned about her children’s welfare during the treatment. When assessing the
     client’s present support systems, the nurse will be most concerned about the potential problems with:
107. Denial as a primary coping mechanism.
108. Support systems and coping strategies.
109. Decision-making abilities.
110. Transportation and money for the boys.

Answer 106

106. 2. The client’s resources for coping with the emotional and practical needs of herself and her
        family need to be assessed because usual coping strategies and support systems are often inadequate
        in especially stressful situations. The nurse may be concerned with the client’s use of denial,
        decision-making abilities, and ability to pay for transportation; however, the client’s support systems
        will be of more importance in this situation.
        CN: Psychosocial integrity; CL: Analyze

Question 107

107. Which of the following characteristics displayed by the wife of a 36-year-old man with
     pancreatic cancer suggests that she may be at risk for negative bereavement outcomes?
108. She is preparing for her husband’s death.
109. Her high socioeconomic status.
110. Her strong family support.
111. She blames herself for her husband’s cancer.

Answer 107

107. 4. Variables that are most predictive of negative bereavement outcomes include anger and
        self-reproach, low socioeconomic status, lack of preparation for death, and lack of family support.
        Making preparations suggests that she is coping with her husband’s approaching death.
        CN: Psychosocial integrity; CL: Analyze

Question 108

108. Which of the following factors assists a person to achieve positive bereavement outcomes?
109. Young age.
110. History of anxiety.
111. History of depression.
112. Higher socioeconomic status.

Answer 108

108. 4. Having a higher socioeconomic status helps a person achieve healthy bereavement.
        Younger people are at higher risk for negative bereavement outcomes. Having a history of depressive
        illness or anxiety is a risk factor for negative bereavement outcomes.
        CN: Psychosocial integrity; CL: Analyze

Question 109

109. Which of the following nursing interventions will be most effective when caring for a client
     who is experiencing powerlessness?
110. Make certain that all staff members focus only on the client’s capabilities.
111. Encourage family members to become more responsible for the client’s care.
112. Request a referral to a psychologist.4. Include the client in decision making whenever possible.

Answer 109

109. 4. Focusing on the client’s physical capabilities is important, but powerlessness reflects a
        perceived lack of control over the current situation and the belief that one’s actions will not affect the
        outcome. Participation in decision making is key to getting the client involved and feeling more incontrol of his own care. Apathy and dependence on others are characteristics of powerlessness.
        Encouraging others to take responsibility for the client’s care will increase his feelings of
        powerlessness. A referral to a psychologist is not necessarily indicated. The nurse should implement
        strategies to involve the client in decisions about his care and evaluate the response to this
        intervention before suggesting a referral.
        CN: Psychosocial integrity; CL: Synthesize

Question 110

110. During the initial stage of adaptation to the diagnosis of cancer and its treatment, the nurse
     can facilitate the client’s adaptation by:
111. Encouraging the client to maintain her usual role.
112. Facilitating family-related disagreements and conflicts.
113. Supporting the client in her use of denial as a coping strategy.
114. Arranging transportation and child care on treatment days.

Answer 110

110. 1. Maintaining role function has been found to be a supportive source of normalcy and
        positive self-esteem for the client and family during the cancer experience. Facilitating family-related
        disagreements and conflicts is not the nurse’s role. Supporting the client in her use of denial as a
        coping strategy will not help facilitate the client’s adaptation to the diagnosis. Arranging
        transportation and child care on treatment days may be helpful but does not necessarily facilitate
        adaptation to the diagnosis.
        CN: Psychosocial integrity; CL: Synthesize

Question 111

111. When explaining hospice care to a client, which of the following statements is most
     appropriate?
112. “Hospice care uses a team approach to direct hospice activity.”
113. “Clients and their families are the focus of care.”
114. “The client’s physician coordinates all the care.”
115. “All hospice clients will die at home.”

Answer 111

111. 2. The most important central component of hospice care is focus of care on the client as
        well as the family or significant other. The team approach and the physician’s coordination of the
        hospice team are important, but they are not the focus. Not all hospice clients want to die at home.
        CN: Basic care and comfort; CL: Apply

Question 112

112. A client’s husband expresses concern that his dying wife keeps saying, “I have to go to the
     store.” Which of the following statements by the nurse will be most effective in assisting the husband
     to understand the dying process?
113. “Many dying clients are restless and can be treated with sedatives.”
114. “The client may be fighting death, and you should leave her alone.”
115. “Comments related to going somewhere or leaving on a trip are common in dying clients.”
116. “Decreased circulation and lack of oxygen to the brain often causes delirium.”

Answer 112

112. 3. Mental changes and decreased level of consciousness are common in the dying process.
        Comments that allude to travel, trips, or going somewhere are also common. Suggesting that the client
        be sedated ignores the husband’s question about what his wife is experiencing. Suggesting that the
        client is fighting death and that the husband should leave her alone is inappropriate and denies the
        husband time to spend with his wife. Although decreased circulation and lack of oxygen may cause
        delirium, delirium is not the norm in the dying process.
        CN: Psychosocial integrity; CL: Synthesize

Question 113

113. The wife of a terminally ill client asks the nurse, “Why is my husband having frequent bowel
     movements if he is not eating?” Which of the following responses by the nurse best informs the wife
     about the client’s condition?
114. “I know he is having frequent loose stools and it is distressing for you, but that’s just the way it
     is.”
115. “I don’t know when the bowels will shut down, but they will eventually.”
116. “The pain medication will eventually help to slow the process of bowel function.”
117. “The intestines still produce some waste products even when a person is not eating.”

Answer 113

113. 4. It is important to give factual information to answer a loved one’s questions and concerns.
        Stating, “That’s just the way it is,” is unprofessional and uncaring. Saying, “I don’t know when the
        bowels will shut down, but they will eventually,” projects an uncaring attitude and does not address
        the wife’s concern for her husband or her need for information. Although it may be true that the pain
        medication will slow bowel function, this does not provide the wife with the information she is
        seeking.
        CN: Psychosocial integrity; CL: Apply

Question 114

114. The client who is in end stages of cancer is requesting spiritual support. The nurse should:
115. Tell the client to start attending religious services.
116. Call a chaplain and set up an appointment for spiritual guidance.
117. Help the client reflect on past accomplishments.
118. Ask the client what spiritual activities would be most helpful.

Answer 114

114. 4. It is important to allow the client to choose his or her own form of spiritual support and
        the nurse can begin by asking the client what would be most supportive now. The dying client who is
        weakened by disease may not be able to attend services. The client must be consulted before referral
        to a chaplain is made. Reflection on past accomplishments may be comforting to the client, but it does
        not directly address spiritual concerns.
        CN: Psychosocial integrity; CL: Synthesize

Question 115

115. A 72-year-old client with end-stage cancer needs assistance with arranging for end-of-life
     home care. The nurse should refer the client to:
116. The client’s oldest child.
117. Social worker.
118. Physician.
119. The executor of the client’s will.

Answer 115

115. 2. A social worker can provide information for supportive services and can help the client
        determine which resources are appropriate. The oldest child may or may not be an appropriate
        resource. The physician will be part of the team, but will focus on the medical aspects of care. The
        client may or may not have a will; it is not the role of an executor to manage home care.CN: Psychosocial integrity; CL: Synthesize

Question 116

116. The family members caring for a client who is near death from colon cancer are concerned
     about dehydration. What should the nurse tell them about dehydration at end of life?
117. The physician will make the decision regarding hydration therapy.2. Dehydration may prolong the dying process.
118. Hydration is used only in extreme situations of dehydration.
119. Dehydration is expected during the dying process.

Answer 116

116. 4. Dehydration is an expected event within the dying process. Hydration may be used in any
        situation of dehydration as long as it is within the client and family’s wishes. Rehydrating the client
        may actually prolong the dying process. Decisions about treatment are made with the family.
        CN: Basic care and comfort; CL: Apply

Question 117

117. Which of the following actions should the nurse plan to do first when caring for a client
     who is experiencing spiritual distress?
118. Make a referral to a member of the clergy.
119. Explain the major beliefs of different religions.
120. Suggest reading material.
121. Help the client explore his or her own values and beliefs

Answer 117

117. 4. The nurse must first allow the client to explore his or her own beliefs and values before
        making referrals, explaining various religious beliefs, or suggesting appropriate reading material.
        CN: Psychosocial integrity; CL: Synthesize

Question 118

118. A nurse is caring for a client at home on hospice care for terminal renal cancer. People are
     calling the nurse to inquire about the client’s condition. The nurse should tell the callers:
119. “Please call the oncologist.”
120. “The client is in a coma now.”
121. “Please call the client’s sister”
122. “The client is not expected to live much longer.”

Answer 118

118. 3. The family is in the best position to give the information they elect to disclose to friends
        and community members. The hospice nurse and the oncologist must maintain client confidentiality
        and follow HIPAA guidelines for release of confidential information. Therefore, disclosing any
        information about the client’s condition would be inappropriate.
        CN: Management of care; CL: Synthesize

Question 119

119. A 42-year-old client with breast cancer is concerned that her husband is depressed by her
     diagnosis. Which of the following changes in her husband’s behavior may confirm her fears?
120. Increased decisiveness.
121. Problem-focused coping style.
122. Increase in social interactions.
123. Disturbance in his sleep patterns.

Answer 119

119. 4. Depression can be a mixture of affective responses (feelings of worthlessness,
        hopelessness, sadness), behavioral responses (appetite changes, withdrawal, sleep disturbances,
        lethargy), and cognitive responses (decreased ability to concentrate, indecisiveness, suicidal
        ideation). Increased decisiveness, problem-solving ability, and increased social interactions are
        reflective of adaptive coping.
        CN: Psychosocial integrity; CL: Analyze

Question 120

120. The most cost-effective suggestion for bereavement support for the hospice nurse to give a
     woman whose husband died 3 months ago and her three young children would be to:
121. Seek group counseling support for the three children.
122. Request individual counseling and medication to manage depression.
123. Remind her gently that bereavement care before death minimizes grieving.
124. Continue bereavement support offered through hospice.

Answer 120

120. 4. Bereavement support after death usually continues for about 1 year or as needed at little or
        no cost to the remaining family. Mutual support groups by nonprofessionals are usually free or
        inexpensive but are not necessarily appropriate for young children. Professional individual
        counseling and medication are expensive, and medication may not be appropriate for young children.
        To remind someone of what she should have done before the death is not helpful at this time.
        CN: Psychosocial integrity; CL: Synthesize

Question 121

121. Which of the following interventions will be most effective in improving transcultural
     communications with clients with cancer and their families?
122. Use touch to show concern and caring for the client.
123. Focus attention on verbal communication skills only.
124. Establish a rapport and listen to their concerns.
125. Maintain eye contact at all times.

Answer 121

121. 3. It is important to establish rapport with the client and family by listening to verbal and
        nonverbal concern and showing respect for cultural differences. The use of touch or eye contact is
        culture-specific and cannot be generalized as an intervention for all individuals with cancer.
        Miscommunication between individuals of different cultures is often caused by language differences,
        rules of communication, age, and gender.
        CN: Psychosocial integrity; CL: Synthesize

Question 122

122. A client with cancer is uncertain about how to cope with all the issues that will arise. The
     nurse can best support the coping behaviors of a client with cancer by:
123. Helping the client identify available resources.
124. Encouraging compliance with treatment regimens.
125. Relieving the client of decision making as much as possible.
126. Assisting the client to prepare for adverse treatment effects.

Answer 122

122. 1. Helping the client to identify available resources allows the client respect and time to
        make informed decisions and encourages him to become actively involved with treatment options.
        Encouraging compliance with treatment regimens discourages the client from becoming actively
        involved in his treatment and diminishes coping ability. Relieving the client of decision making as
        much as possible is not appropriate and encourages feelings of helplessness and powerlessness.
        Assisting the client to prepare for adverse treatment effects may foster hopelessness and increase
        anxiety by focusing on adverse outcomes too soon.
        CN: Psychosocial integrity; CL: Synthesize

Question 123

123. Which of the following is an expected outcome of a nursing referral to a cancer support
     group? The client can:
124. Choose the best treatment options.2. Find financial help.
125. Obtain home health care.
126. Cope with cancer.

Answer 123

123. 4. Support groups are designed to educate clients and their families experiencing cancerabout the disease and methods of coping positively with it. These are self-help and support groups
        monitored by professionals and cancer survivors who have undergone a training course that helps
        them to facilitate small groups.
        CN: Psychosocial integrity; CL: Apply

Question 124

124. A cancer survivor feels guilty when attending a cancer support group meeting. The nurse can
     help the client manage feelings of guilt by pointing out that:
125. These actually are feelings of anger at the terminally ill clients in the group.
126. It is an unexpected response to volatile emotions.
127. This is a spiritual response to the client’s own illness.
128. This is a normal reaction when surviving a life-threatening experience.

Answer 124

124. 4. Many cancer survivors question why they are doing so well and others are not. Often they
        express feeling guilty when they hear that others are not doing well. Suggesting that the client does not
        know how to describe his own emotions is inappropriate and may discourage him from expressing his
        feelings. Although the client may be experiencing volatile emotions, this is not the likely source of his
        feelings of guilt. Guilt about doing well after cancer treatment is not a spiritual response to illness.
        CN: Psychosocial integrity; CL: Synthesize

Question 125

125. A 68-year-old client with colon cancer experiences an increase in feelings of anxiety and
     depression and has suicidal ideation. The nurse realizes that these feelings occur during which stage
     of the disease?
126. Initiation of definitive treatment.
127. End of the first course of treatment.
128. End stage of the disease.
129. Recurrence of the disease.

Answer 125

125. 4. The recurrence of the disease is found to be the most distressing time, and clients may
        experience anxiety, depression, and suicidal ideation. Clients may feel a decrease in their anxiety and
        depression with the initiation of definitive treatment or at the end of their first course of treatment.
        Clients in the end stage of the disease may feel all of these emotions; however, when clients have
        been free from cancer for some time and learn that there is a recurrence, they often experience a sharp
        increase in their feelings of distress.
        CN: Psychosocial integrity; CL: Analyze

Question 126

126. The 65-year-old widower whose only son is 500 miles (805 km) away is at higher risk for
     psychosocial distress because the client:
127. Has been successful in dealing with stress all his life.
128. Does not have to deal with other stressors right now.
129. Is able to use denial as a coping mechanism.
130. Perceives he has minimal social support.

Answer 126

126. 4. The person who has minimal social support, has not been successful in dealing with
        stressors, and has multiple other stressors is at greater risk for psychosocial distress. Being
        successful in dealing with stress all his life would decrease the client’s risk for psychosocial distress.
        Not having to deal with other stressors would be helpful in managing the current stressful situation.
        The denial coping mechanism, if used for short periods, can decrease the risk for psychosocial
        distress.
        CN: Psychosocial integrity; CL: Analyze

Question 127

127. A client with a diagnosis of cancer is frequently disruptive and challenges the nurse. This
     behavior may be caused by:
128. Uncertainty and an underlying fear of recurrence.
129. The usual trajectory of a short-term illness.
130. A history of a behavioral illness.
131. The one-time crisis from learning of the diagnosis.

Answer 127

127. 1. Clients with cancer report that the lifelong fear of recurrence is one of the most disruptive
        aspects of the disease. The trajectory of the disease is unpredictable and can be intertwined with
        many short- and long-term illnesses related to cancer and the treatment modalities. A diagnosis of
        cancer challenges the individual and the family with a series of crises rather than a time-limited
        episode. There are no data to indicate that the client has an underlying behavioral disorder.
        CN: Psychosocial integrity; CL: Analyze

Question 128

128. A 42-year-old husband and father of a 7-year-old girl and a 10-year-old boy is concerned
     about what he should tell his children regarding his wife’s impending death from aggressive breast
     cancer. The nurse should first:
129. Refer the family to pastoral care services.
130. Encourage the husband to come to terms with his own grief first.
131. Suggest that the children be told nothing until after death occurs.
132. Begin education about strategies for communication with his children

Answer 128

128. 4. Without clear, consistent communication, the parent-child relationship may become
        strained during the illness and subsequent death of a parent. A great number of parents do not know
        how to communicate with their children, especially about difficult emotional topics at a time when
        they are also under great emotional stress. The nurse should begin by providing information and
        developmentally appropriate books about the grieving process for children. Referral to pastoral care
        services may be appropriate; however, the nurse’s direct intervention of beginning education about
        strategies for communication will be of immediate and long-term benefit. The grieving process cannot
        be rushed for the husband, nor should an opportunity for the father and children to communicate and
        grieve together be delayed. Excluding children from participating in the grieving ritual is not
        shielding them from the sorrow and sadness.
        CN: Psychosocial integrity; CL: Synthesize

Question 129

129. While talking to her husband, who is caring for their children, a 52-year-old client slams the
     phone down. She begins to cry and states that she is feeling guilty for being hospitalized. Which of the
     following will best support the client emotionally?
130. Call the physician and ask for a psychiatry consultation.
131. Call the physician and request an antidepressant medication.
132. Sit with the client and help her acknowledge and discuss her feelings.
133. Sit with the client and encourage her to see the good side of the situation.

Answer 129

129. 3. Acknowledgment and discussion of the client’s feelings begin the establishment of a
        therapeutic relationship between nurse and client. It also acknowledges the seriousness of the current
        situation and validates the client’s feelings. Psychiatric help and antidepressant medication may be
        options if the depression is severe and prolonged. Encouraging a client to see the good or positive
        side of a situation minimizes the client’s feelings.
        CN: Psychosocial integrity; CL: Synthesize

Question 130

130. A 56-year-old female who is receiving radiation therapy tells the nurse that she feels
     inadequate as a wife and mother because she can no longer carry out her usual duties with the same
     energy as before. What recommendations should the nurse make to help the client cope with this
     situation?
131. Suggest that she reassign all household chores to other members of the family.
132. Suggest that she prioritize her activities and ask for help from friends and family.
133. Suggest that she ignore the household chores during the crisis period.
134. Tell her not to worry so much because everyone gets a little tired at this phase of the therapy.

Answer 130

130. 2. Individuals who are experiencing fatigue need to prioritize their activities and ask for
        assistance from others. It is best not to take away all of the client’s activities because her role as wife
        and mother is obviously important to her and to her sense of self-worth. Suggesting that she ignore the
        household chores or telling her not to worry because everyone gets tired disregards the client’s
        feelings and is not appropriate.
        CN: Basic care and comfort; CL: Synthesize

Question 131

131. A 66-year-old female who is usually meticulous about her appearance and dress arrives
     today for her 23rd day of radiation therapy. She appears disheveled and emotionally labile, and her
     responses to the usual questions are a little inappropriate. Her heart rate is 124 bpm, her respirations
     are 32 breaths/min, and her skin is cold and clammy. These findings would suggest that the nurse
     should further assess the client for which of the following conditions?
132. Schizophrenia.
133. Panic disorder.
134. Depression.
135. Delirium.

Answer 131

131. 4. Tachycardia, tachypnea, moist or clammy skin, and disorientation are classic symptoms of
        delirium. Clients with panic disorder do not exhibit disorientation. Clients with depression exhibit a
        flat affect, apathy, and sleep disturbances. Clients with schizophrenia have thought disorders such as
        hallucinations or delusions.
        CN: Physiological adaptation; CL: Analyze

Question 132

132. A client has undergone surgical resection for lung cancer. Which of the following will
     promote adaptation and rehabilitation?
133. Arranging a visit from a member of the American Cancer Society Lost Chord Club (Canadian
     Lung Cancer Society).
134. Planning a progressive activity regimen with the client.
135. Teaching tracheostomy care.
136. Planning a vigorous exercise program.

Answer 132

132. 2. A progressive activity regimen may be prescribed to increase pulmonary function after
        surgical lung resection. Rehabilitation should include walking and some stair climbing as tolerated.
        Vigorous exercise is usually not recommended initially. Joining the Lost Chord Club (Canadian Lung
        Cancer Society) and learning tracheostomy care are appropriate for the client who has undergone a
        laryngectomy.
        CN: Psychosocial integrity; CL: Synthesize

Question 133

133. Which of the following activities indicates that the client with cancer is adapting well to
     body image changes?
134. The client names his brother as the person to call if he is experiencing suicidal ideation.
135. The client discusses changes in body structure and function.
136. The client discusses the date of his return to work.
137. The client serves as a volunteer in a client-to-client visitation program

Answer 133

133. 4. Serving as a volunteer in a client-to-client program represents reintegration with
        constructive channeling of energies, which indicates a higher level of adaptation than attention to
        safety, knowledge, or planned activity.
        CN: Psychosocial integrity; CL: Evaluate

Question 134

The Client Who Is Experiencing Problems with
Sexuality
134. A 36-year-old female has increased vaginal dryness during sexual intercourse. She has
received chemotherapy in the past and has menopausal symptoms due to ovarian suppression. An
appropriate nursing intervention would be to instruct the client on the use of:
1. Vaginal dilators.
2. Nightly douches.
3. Water-soluble vaginal lubricants.
4. Relaxation techniques.

Answer 134

The Client Who Is Experiencing Problems with Sexuality
134. 3. Water-soluble lubricants used during sexual intercourse can augment reduced natural
vaginal lubrication caused by ovarian dysfunction and decreased circulating estrogen related to
chemotherapy. The use of vaginal dilators, relaxation techniques, or nightly douches would not
increase vaginal lubrication. Frequent douching can disrupt the normal vaginal environment.
CN: Health promotion and maintenance; CL: Synthesize

Question 135

135. A 49-year-old male with a tracheostomy tube confides to the nurse that he is beginning to
     avoid sexual activity because of the increased tracheostomy secretions. Which of the following
     statements by the nurse will be most helpful to the client?
136. “Use a scopolamine patch to decrease secretions.”
137. “Avoid fluid intake 2 hours before sexual activity.”
138. “Place a thin piece of gauze over the tracheostomy.”
139. “Wash the tracheostomy area with deodorizing antibacterial soap before sexual activity.”

Answer 135

135. 3. Placing a thin piece of gauze over the tracheostomy during sexual activity will help to
        contain the secretions and yet allow ventilation. Although a scopolamine patch may depress the
        salivary and bronchial secretions, it is not recommended for long-term use and would not be
        indicated in this situation. Avoiding fluids before sexual activity is not recommended to decrease
        secretions. Washing the tracheostomy area with any deodorizing soap may cause skin irritation and
        place the client at risk for infection.
        CN: Health promotion and maintenance; CL: Synthesize

Question 136

136. A 52-year-old client is scheduled for a total abdominal hysterectomy for cervical cancer.
     When discussing the potential impact of this procedure on the client’s sexuality, which of the
     following comments is most appropriate?
137. “All women experience sexual problems with this surgical procedure. Do you have any
     questions?”
138. “When can I schedule an appointment with you and your partner to discuss any issues either of
     you may have regarding sexuality?”
139. “Do you anticipate any problems with sex related to your scheduled hysterectomy?”
140. “Most women have concerns about their sexuality after this type of surgery. Do you have any
     concerns or questions?”

Answer 136

136. 4. This question introduces some basic information and allows for support for the client who
        may be experiencing some sexuality concerns. Not all women experience sexual problems after
        undergoing a hysterectomy. Assuming that the client will want to schedule an appointment with her
        partner is inappropriate and may embarrass her. Simply asking the client whether she expects to have
        problems with sex is too abrupt and does not provide any information.
        CN: Psychosocial integrity; CL: Synthesize

Question 137

137. A young man with early-stage testicular cancer is scheduled for a unilateral orchiectomy.
     The client confides to the nurse that he is concerned about what effects the surgery will have on his
     sexual performance. Which of the following responses by the nurse provides accurate information
     about sexual performance after an orchiectomy?
138. “Most impotence resolves in a couple of months.”
139. “You could have early ejaculation with this type of surgery.”
140. “We will refer you to a sex therapist because you will probably notice erectile dysfunction.”
141. “Because your surgery does not involve other organs or tissues, you’ll likely not notice much
     change in your sexual performance.”

Answer 137

137. 4. Although there may not be a big change in sexual function with a unilateral orchiectomy,
        the loss of a gonad and testosterone may result in decreased libido and sterility. Sperm banking may
        be an option worth exploring if the number and motility of the sperm are adequate. Remember, the
        population most affected by testicular cancer is generally young men aged 15 to 34, and in this crucial
        stage of life, sexual anxieties may be a large concern.
        CN: Psychosocial integrity; CL: Synthesize

Question 138

138. A young female client is receiving chemotherapy and mentions to the nurse that she and her
     husband are using a diaphragm for birth control. Which of the following is most important for the
     nurse to discuss?
139. Inconvenience of the diaphragm.
140. Transmission of sexually transmitted diseases.3. Body changes related to hormones.
141. Infection control.

Answer 138

138. 4. The risk of becoming neutropenic during chemotherapy is very high. Therefore, an
        inserted foreign object such as a diaphragm may be a nidus for infection. Although the nurse may wish
        to inform the client about the ease with which various contraceptive modalities may be used, the
        focus of this discussion should be on preventing an infection, which can be fatal for the neutropenic
        client. There are no data to suggest the client is at risk for acquiring a sexually transmitted disease.
        The client will not be experiencing body changes directly related to hormonal changes.
        CN: Safety and infection control; CL: Synthesize

Question 139

139. To promote comfort and optimal respiratory expansion for a client with chronic obstructive
     pulmonary disease during sexual intimacy, the nurse can suggest that the couple:
140. Use a waterbed.
141. Use pillows to raise the affected partner’s head and upper torso.
142. Have the affected partner assume a dependent position.
143. Limit the duration of the sexual activity.

Answer 139

139. 2. Raising the upper torso for the affected partner facilitates respiratory function. The use of
        a waterbed may be helpful for the sensation of movement, but it does not promote respiratory
        expansion. A dependent position may compromise respiratory expansion, even though energy may be
        conserved. Duration of sexual activity is not necessarily related to exertion.
        CN: Health promotion and maintenance; CL: Synthesize

Question 140

Ethical and Legal Issues Related to Clients with
Cancer
140. A registered nurse is assigning care on the oncology unit and assigns the client with
Kaposi’s sarcoma and human immunodeficiency virus (HIV) infection to the licensed vocational nurse
(LVN-LPN). The LVN-LPN does not want to care for this client. How should the nurse respond?
1. “I will assign this client to another nurse.”
2. “I will help you take care of this client so you are confident with the care.”
3. “You seem worried about this assignment.”
4. “I will review blood and body fluid precautions with you.”

Answer 140

Ethical and Legal Issues Related to Clients with Cancer
140. 3. The registered nurse assigning care should first give the LVN-LPN the opportunity to
explore concerns and fears about caring for a client with HIV infection. Reassigning care for this
client, assisting with care, and reviewing precautions do not address the present concern or create an
environment that will generate useful knowledge regarding future assignments for client care.
CN: Management of care; CL: Synthesize

Question 141

141. A woman employed full-time wants to request a leave of absence to care for her father who
     is being treated for colon cancer 300 miles (483 km) away. The nurse should advise the client to do
     which of the following first?
142. Contact her employee resources department about policies guiding leaves of absence.
143. Make a plan to see how long she can be out of work without financial concerns.
144. Find someone to do her work while she is away.
145. Ask her father if he can afford a caregiver.

Answer 141

141. 1. The nurse should advise the client to check with her employer to determine the policies
        and legislation followed there regarding leaves of absence. While the client can consider the other
        options, the first step is to obtain information from her employer.
        CN: Management of care; CL: Apply

Question 142

142. The nurse is developing a care plan for a client with cancer receiving hospice home care.
     Which would be most appropriate for managing the client’s chronic pain?
143. Administer analgesics regularly and additionally as needed for break-through pain.
144. Sedate the client with tranquilizers.
145. Avoid intravenous pain medication until the client is terminal.
146. Administer analgesics when vital signs indicate increased pain severity.

Answer 142

142. 1. Maintaining a steady blood level of analgesics is beneficial for the client with chronic
        cancer pain. Administering analgesics regularly helps control pain more efficiently. Additional doses
        of medication may be necessary as ordered for break-through pain. Keeping the client overly sedated
        may not help to control pain. Intravenous analgesics are more effective than oral medications at
        controlling pain, because their distribution is more predictable. Vital signs are not a reliable indicator
        of how much pain the client is experiencing.CN: Management of care; CL: Apply

Question 143

143. A client and nurse have established a goal for the client to be more autonomous in decision
     making. Which of the following situations indicates that the goal has been met?
144. The physician directs the client’s care.
145. The nurse provides the client with the facts and then allows the client to reach an unassisted
     decision.
146. The nurse respects a client’s choice not to know particular information.
147. The health care team makes health and treatment decisions.

Answer 143

143. 3. The goal of client autonomy is to respect the client’s choice not to know particular
        information. The client’s best interests should be determined by the client after he or she receives all
        the necessary information and in conjunction with other people of the client’s choice, including family,
        physicians, and other health care personnel. The client’s best interests are not totally directed by the
        physician or the health care team.
        CN: Management of care; CL: Evaluate

Question 144

End-of-Life Care
144. The family of a hospitalized client demonstrates understanding of the teaching about
advance directives when they make which of the following statements? Select all that apply.
1. “Advance directives give instructions about future medical care and treatment.”
2. “If people are not capable of communicating their wishes, health care providers and family
together can agree on measures or actions that will be taken.”
3. “Ethics experts agree that the family is the sole deciding factor when the client is competent.”
4. “Medical power-of-attorney gives primarily financial access to the designee.”
5. “Medical power-of-attorney or durable power-of-attorney for health care is a document that
lists who can make health care decisions should a person be unable to make an informed
decision for himself or herself.”
6. “Advance directives give details about the client’s past medical history.”

Answer 144

End-of-Life Care
144. 1, 2, 5. Advance directives are written statements of person’s wishes related to health care if
they are unable to decide for themselves. These documents relate to current or future health care and
not past medical history. Competent adults are responsible for their own health care decisions and
their own right to accept or refuse treatment. Advance directives are used when the person cannot
make the decision. Medical power-of-attorney is a term used to describe the person who makes
health care decisions should someone be unable to make informed decisions for himself or herself.
The focus is not primarily financial access.
CN: Management of care; CL: Evaluate

Question 145

145. The nurse can be an important advocate for the client who is considering an alternative
     method of cancer treatment. Which of the following statements best demonstrates the nurse as client
     advocate? The nurse will:
146. Provide the information about standard therapies.
147. Monitor blood tests as indicated by the alternative therapy.
148. Document the client’s desire to try an alternative therapy.
149. Allow the client to make health care choices but will assist in ensuring the client is fully
     informed when making those decisions.

Answer 145

145. 4. The advocacy role of the nurse implies that the nurse will ensure that the client’s wishes
        are being respected and the client is making informed decisions. Therefore, the nurse will assist in
        ensuring that the client is fully informed. The other interventions are appropriate for the nurse but are
        not related to client advocacy. The client may not understand or have all the necessary information for
        standard therapy. A client who is taking an alternative therapy should be monitored for adverse
        effects. If a client is taking an alternative therapy, it is essential for the physician to know so that the
        therapy can be incorporated into the client’s treatment plan and to ensure that there are no
        incompatibilities with other therapies or medications.
        CN: Management of care; CL: Evaluate

Question 146

146. After completing the nursing assessment for a client and family entering the palliative care
     program, the nurse should develop a teaching plan that includes an understanding of which of the
     following outcomes? Select all that apply.
147. Alteration in the family’s usual coping strategies.
148. Achievement of a dignified and respectful death.
149. Improvement in the client’s quality of life.
150. Provision of comfort during the dying process.
151. Provision of support for client and family.
152. Advocation for prolonging life while curing the disease.

Answer 146

146. 2, 3, 4, 5. End-of-life care is the term currently used for issues related to death and dying.
     End-of-life care focuses on physical and psychosocial needs at the end of life for the client and
     client’s family. Palliative care is health care aimed at symptom management rather than curative
     treatment for diseases. Goals would include providing comfort and support for the client and family
     and improving the client’s quality of life. Grief counseling is a component and efforts would be to
     enhance the coping of all involved and not to alter usual coping methods.
     CN: Management of care; CL: Create

Question 147

147. When a client and family receive the initial diagnosis of colon cancer, the nurse can act as
     an advocate by:
148. Helping them maintain a sense of optimism and hopefulness.
149. Determining their understanding of the results of the diagnostic testing.
150. Listening carefully to their perceptions of what their needs are.
151. Providing them with written materials about the cancer site and its treatment.

Answer 147

147. 3. The best nursing advocacy intervention is listening carefully to the client’s and family’s
        perceptions of their needs. Studies have demonstrated that these needs are not necessarily what the
        nurse thinks they are. Intervening without listening carefully may result in a lack of responsiveness to
        the real needs. Helping the client and family maintain a sense of optimism and hopefulness is
        appropriate but is not necessarily advocacy. Determining the client’s and family’s understanding of the
        results of the diagnostic testing and providing written materials about the cancer site and its treatment
        are examples of the nurse’s role as educator.
        CN: Psychosocial integrity; CL: Synthesize

Question 148

148. A client who is dying of acquired immunodeficiency syndrome (AIDS) is admitted to the
     inpatient psychiatric unit because he attempted suicide. His close friend recently died of AIDS. The
     client begins to talk about his feelings related to his illness and the loss of his friend. He begins to
     cry. Which of the following responses by the nurse would be most appropriate?
149. Give the client some tissues and tell him it is okay to cry.
150. Tell the client to stop crying and that everything will be okay.3. Sort the client’s mail to distract the client.
151. Change the subject.

Answer 148

148. 1. The nurse would give the client a tissue and indicate that it is okay to cry to convey
        acceptance and empathy. He needs to know that it is natural to have tremendous feelings of loss and
        sadness. Telling the client to stop crying, busying oneself in the client’s room, and changing the subject
        are not helpful to the client because they ignore his needs and inhibit the expression of emotion.
        CN: Psychosocial integrity; CL: Synthesize

Question 149

149. The wife of an older adult who has been admitted to the hospital with kidney failure tells the
     nurse, “I know he doesn’t want to die in a hospital, but it is so hard for me to take care of him at home.
     He said he doesn’t want any more treatment, but I’m not ready to let him go. We have so many
     arrangements to decide before he dies.” Which of the following statements by the nurse to the client’s
     wife would be most appropriate? Select all that apply.
150. “He’s not going to die that soon judging by his current symptoms.”
151. “What are your fears about your husband dying?”
152. “I can imagine that it is hard for you to care for him at home.”
153. “What do you and your husband know about advance directives?”
154. “We can discuss types of hospice and home care available.”
155. “What kind of arrangements do you think need to be made before he dies?”

Answer 149

149. 2, 3, 4, 5, 6. With serious, chronic, and terminal illnesses, it is important to help clients and
     families address fears, difficulties with home care, advance directives, hospice and home care
     options, and final arrangements. Predicting the length of life for this client is not appropriate at
     admission.
     CN: Psychosocial integrity; CL: Synthesize

Question 150

150. A terminally ill client’s husband tells the nurse, “I wish we had taken that trip to Europe last
     year. We just kept putting it off, and now I’m furious that we didn’t go.” The nurse interprets the
     husband’s statement as indicating which of the following stages of adaptation to dying?
151. Anger.
152. Denial.
153. Bargaining.
154. Depression.

Answer 150

150. 1. The client’s husband is experiencing anger, much of which stems from feelings of guilt
        about not taking the trip. During the stage of denial, the husband is more likely to deny the client’s
        diagnosis and prognosis. During the stage of bargaining, the husband would offer to do certain things
        in exchange for more time before the client dies. In the stage of depression, the husband is likely to
        make few or no comments and to act dejected.
        CN: Psychosocial integrity; CL: Analyze

Question 151

151. Which of the following philosophies should the nurse integrate into the plan of care for a
     client and family to help them best cope during the final stages of the client’s illness?
152. Living each day as it comes as fully as possible.
153. Reliving the pleasant memories of days gone by.
154. Expecting the worst and being grateful when it does not happen.
155. Planning ahead for the remaining good times that will be spent together.

Answer 151

151. 1. When supporting the friends or family of a terminally ill client, it is best to focus on the
        present. This can be accomplished by living each day to its fullest. Friends and families also want to
        know what to expect and want someone to listen to them as they express grief over the approaching
        death. Focusing on the past can interfere with enjoying the present. Expecting the worst interferes
        with focusing on day-to-day positive experiences. Planning ahead is inappropriate because of
        uncertainty when the length of life is unknown.
        CN: Psychosocial integrity; CL: Synthesize

Question 152

152. A client who is in the end stages of cancer is increasingly upset about receiving
     chemotherapy. Which of the following approaches by the nurse would likely be most helpful in
     gaining the client’s cooperation?
153. Telling the client how the treatment can be expected to help.
154. Describing the probable effect on that missing a treatment would have.
155. Saying “Be a good client and not make the treatment any harder for yourself.”
156. Promising to give a backrub when the treatment is completed.

Answer 152

152. 1. The best course of action when the client has outbursts concerning treatments is to explain
        how the treatment is expected to help. Describing the effect if the client misses a treatment is a
        negative approach and may be threatening to the client. The client is likely to feel angry if told to be a
        “good client” during treatments. Offering to give the client a backrub does not give information to the
        client and may negatively reinforce the behavior.
        CN: Psychosocial integrity; CL: Synthesize

Question 153

153. A client suspects that he will not live. However, others talk about only pleasant matters with
     him and maintain a persistently cheerful facade around him. The nurse anticipates that the client will
     most likely feel which of the following as a result of such behavior?
154. Relief.
155. Isolation.
156. Hopefulness.
157. Independence.

Answer 153

153. 2. Clients tend to experience isolation and loneliness when those around them are trying to
        hide or mask the truth. They are then left to face the realities of death alone. Clients do not experience
        relief or hopefulness when others are falsely cheerful. Independence is promoted by offering realistic
        choices about care at the end of life.
        CN: Health promotion and maintenance; CL: Analyze

Question 154

154. The young sister of a young adult client with leukemia asks, “Can you check my blood?
     When my sister got the measles, so did I. And I think I have this, too.” Which of the following by thenurse would be inappropriate?
155. Asking the client’s physician to take a sample of the sister’s blood.
156. Explaining to the sister that leukemia is not a communicable disease.
157. Discussing the sister’s concern with her parents.
158. Telling the sister’s parents about a group for siblings of clients with terminal illness.

Answer 154

154. 1. Taking a blood sample is an unnecessary, invasive procedure that would not directly
        address the sister’s fear. Leukemia is not considered a communicable disease. Providing an
        explanation and alerting the parents to the sibling’s concern and the resources available to assist
        siblings to deal with the terminal illness are all appropriate interventions.
        CN: Psychosocial integrity; CL: Synthesize

Question 155

155. When talking with the nurse, the brother of a client with leukemia says, “We used to play
     pretty rough games together. Maybe some of the bruises he got when I tackled him caused this.”
     Which of the following would be the nurse’s best response?
156. “Don’t feel guilty. You didn’t cause your brother’s illness.”
157. “I can see you’re worried. Let’s talk about how people get leukemia.”
158. “Here is some information about leukemia for you to read.”
159. “Lots of people worry about things like this. It isn’t your fault.”

Answer 155

155. 2. A response that acknowledges the brother’s concern and provides him with information ismost helpful. Therefore, telling the brother that the nurse sees that he is worried and then following
        this up with a discussion about leukemia is most appropriate. Providing reassurance or information
        without acknowledging the expressed concern is not as helpful as acknowledging the concern and
        providing the information. Although acknowledging his worry is appropriate, more importantly, the
        brother needs factual information about the disease.
        CN: Psychosocial integrity; CL: Synthesize

Question 156

156. During the nursing shift report, the team leader lists tasks and routines completed for a
     terminally ill client. Which of the following kinds of behavior is the nurse most likely demonstrating
     when emphasizing the technical aspects of caring for a dying client?
157. Tactful behavior.
158. Efficient behavior.
159. Objective behavior.
160. Defensive behavior.

Answer 156

156. 4. The nurse caring for a terminally ill client who reports only tasks and routines completed
        for the client is probably behaving defensively. This behavior does not convey compassion and caring
        for the client. It is likely that this nurse has not come to grips with death and dying. Tactful behavior
        respects the client’s needs. Efficient care will prevent unnecessary disturbance for the client. When
        caring for a terminally ill client, the nurse can remain objective while providing comprehensive
        nursing care to this client.
        CN: Psychosocial integrity; CL: Analyze

Question 157

Managing Care Quality and Safety
157. The nurse is caring for a client with end-stage cancer whose health status is declining. A
prescription is written by the attending physician to withhold all fluid, but the health care team cannot
locate a family member or guardian. The nurse requests an ethics consultation. Which of the following
is true of an ethics consultation? Select all that apply.
1. Persons requesting an ethics consultation may do so without intimidation or fear of reprisal.
2. Ethics consultations may prevent poor outcomes in cases involving ethical problems.
3. The recommendations of ethics consultants are advisory only.
4. Requests for ethics consultations may only be made by the physician or nurse.
5. Ethics consultation is intended to provide legal advice on client care.

Answer 157

Managing Care Quality and Safety
157. 1, 2, 3. Ethics consultation seeks to facilitate communication and shared decision making in
client care. Ethics consultations also tend to increase knowledge of clinical ethics, improve client
care, and prevent poor outcomes in cases involving ethical problems. Requests for ethics
consultations can be made by any member of the health care team and by clients, family members,
guardians, students, or others with a legitimate interest in the client. The recommendations of ethics
consultants are advisory only; the ethics consultation process is intended to supplement and support
existing departmental and institutional mechanisms for making decisions and resolving conflict in
clinical practice. Clinicians are encouraged to seek an ethics consultation when the client is
incapacitated when no family member/s or guardian/s exist or can be found, or when the client’s
family members disagree about the ethically appropriate action to be taken. Ethics consultation is not
intended or authorized to provide legal advice on client care. Persons requesting an ethics
consultation may do so without intimidation or fear of reprisal.
CN: Management of care; CL: Synthesize

Question 158

158. The nurse-manager on the oncology unit wants to address the issue of correct documentation
     of the effectiveness of analgesia medication within 30 minutes after administration. What should the
     nurse-manager do first?
159. Change the policy of documentation to 45 minutes.
160. Consult the pharmacist.
161. Consult the nurses on the evening shift where documentation of analgesia is the greatest
     problem.
162. Complete a brief quality improvement study and chart audit to document the rate of adherence
     to the policy and the pattern of documentation over shifts.

Answer 158

158. 4. To determine the cause of this problem, a quality improvement study should be conducted.
        Before implementing solutions to a problem, the precise issues in the hospital system must be
        observed and documented. It is not the pharmacist’s role to provide consultation about documentation
        of drugs administered by nurses. Consulting the evening nurses may be helpful, but this is a systems
        issue of the entire unit and involves every registered nurse administering analgesia.
        CN: Management of care; CL: Create

Question 159

159. A registered nurse (RN) instructs the unlicensed assistive personnel (UAP) to check the
     urine intake and output (I&O) on clients on the oncology unit at the end of the 8-hour shift. It is
     important for the nurse to instruct the UAP to do what?
160. Ask the clients if they are thirsty when calculating the I&O.
161. Report back to the nurse immediately if any client has an output less than 240 mL.
162. Document the I&O results on the medical records.
163. Write the I&O results down for the nurse to give report to the next shift.

Answer 159

159. 2. The RN is responsible for describing to the UAP when to report to the RN a result that
        indicates a potential client problem with dehydration. The RN must assess and interpret results, but
        must give concrete feedback to the UAP on what is an expected situation or a specific result to report
        back to the RN. Urine output should be at least 30 mL/h, or 240 mL over the 8-hour shift. Dehydrated
        clients may be thirsty and the UAP can ask if the client is thirsty and offer water if permitted.
        However, because urine output is the critical indicator of dehydration, the UAP should document I&O
        and give results outside the normal range to the nurse. The nurse is specifically assessing dehydration
        and should request to receive this information.CN: Management of care; CL: Synthesize

Question 160

160. An alert and oriented older adult female with metastatic lung cancer is admitted to the
     medical-surgical unit for treatment of heart failure. She was given 80 mg of furosemide (Lasix) in the
     emergency department. Although the client is ambulatory, the unlicensed assistive personnel are
     concerned about urinary incontinence because the client is frail and in a strange environment. The
     nurse should instruct the unlicensed personnel to assist with implementing the nursing plan of care by:
161. Prescribing adult diapers for the client so she will not have to worry about incontinence.
162. Requesting an indwelling urinary catheter to avoid incontinence.
163. Padding the bed with extra absorbent linens.
164. Placing a commode at the bedside and instructing the client in its use.

Answer 160

160. 4. A bedside commode should be near the client for easy, safe access. Measurement of urine
        output is also important in a client with heart failure. Putting diapers on an alert and oriented
        individual would be demeaning and inappropriate. Indwelling catheters are associated with increased
        risk of infection and are not a solution to possible incontinence. There is no reason to think that the
        client would not be able to use the bedside commode.
        CN: Safety and infection control; CL: Synthesize

Question 161

161. The nursing team on an oncology unit consists of a registered nurse (RN), a licensed
     vocational nurse (LVN-LPN), and unlicensed assistive personnel (UAP). Which client should be
     assigned to the RN?
162. A 52-year-old client with lung cancer admitted for acute dyspnea.
163. A 45-year-old client receiving tube feedings.
164. A 28-year-old client being evaluated for a bone marrow transplant.4. A 65-year-old client diagnosed with endometrial cancer who underwent an abdominal
     hysterectomy 3 days ago.

Answer 161

161. 1. Ongoing assessment by the RN is required to evaluate the client with dyspnea to monitor
        for potential deterioration of the respiratory status. If the RN is the care provider, the RN will have
        greater interaction with the individual client. The RN is responsible for assessment of all the clients.
        The other clients would not be considered unstable, and maintaining a patent airway is always the
        priority in providing care. Care for the other clients could be assigned safely, according to the
        abilities of the LVN-LPN and UAP.
        CN: Management of care; CL: Synthesize

Question 162

162. The nurse is to wear personal protective equipment (PPE) to administer a chemotherapeutic
     agent to the client. The nurse should use which of the following guidelines for PPE use and care?
     Select all that apply.
163. Understand the proper use and limitations of PPE.
164. Use care in removing all items to reduce contamination.
165. Ensure that PPE is made of materials that allow for air ventilation.
166. Cleanse hands with alcohol-based solution before putting gloves on and after removing gloves.
167. Discard the PPE in containers for contaminated waste.

Answer 162

162. 1, 2, 5. Employers should provide appropriate PPE to protect workers who handle
     hazardous drugs in the workplace. The following general guidelines apply to PPE use and care: select
     specific respirators and protective clothing based on an assessment of the potential exposure to
     hazardous drugs; understand proper use and limitations of any selected PPE to ensure that it functions
     properly; use care in donning and removing all items to prevent damage to PPE and to reduce the
     spread of contamination. The PPE must be constructed of materials that are appropriate for hazardous
     drug exposure. Hands must be thoroughly washed with soap and water both before donning and after
     removing gloves. Consider all PPE worn when handling hazardous drugs as being contaminated;
     contain and dispose of such PPE as contaminated waste.
     CN: Safety and infection control; CL: Synthesize

Question 163

163. The nurse should ensure that which of the following is placed when the client is to receive
     intravascular therapy for more than 6 days?
164. Short peripheral catheter.
165. Central venous access in the femoral vein.
166. Steel needle in the subclavian vein.
167. Peripherally inserted central catheter (PICC).

Answer 163

163. 4. When the duration of intravascular therapy is likely to be more than 6 days, a midline
        catheter or peripherally inserted central catheter (PICC) is preferred to a short peripheral catheter. In
        adult clients, use of the femoral vein for central venous access should be avoided. Steel needles
        should be avoided when administering fluids and medications that might cause tissue necrosis if
        extravasation occurs.
        CN: Reduction of risk potential; CL: Apply