Nursing 202 Exam 2 Questions and Answers - Cancer Nursing Care Exam

A nurse is assessing a client with a family history of cancer. Which finding requires immediate follow-up? A. The client has gained 10 lb (4.5 kg) over the past year. B. The client reports knee pain upon rising. C. The client reports a feeling of a lump in the throat. D. The client has a blood pressure of 135/80 mmHg and a pulse rate of 70 beats/minute. - C. The client reports a feeling of a lump in the throat. The sensation of a lump in the throat is one of the warning signs of esophageal cancer and requires immediate follow-up. Other symptoms of esophageal cancer include dysphagia, substernal pain, regurgitation of undigested food, foul breath, and hiccups. A weight gain of 10 lb in a year, a blood pressure of 135/80 mmHg, and a pulse rate of 70 beats/minute are normal findings. Although the nurse should ultimately investigate the complaint of pain in the knees upon rising, this finding isn't the priority at this time. A client, age 42, visits the gynecologist. After examining the client, the healthcare provider suspects cervical cancer. What will be most important for the nurse to include in assessing the client's health history? A. the onset of sexual activity B. smoking history C. diet and exercise D. history of human papillomavirus infection - D. history of human papillomavirus infection The nurse would assess for risk factors associated with cervical cancer. The most important risk factor for cervical cancer is human papillomavirus infection. The onset of sexual activity may indirectly increase the risk of cervical cancer. Smoking is a risk factor for cervical cancer but not the most important one. Diet and exercise are not important risk factors for cervical cancer. A client who is receiving chemotherapy expresses concern at the thought of losing hair on the head. The nurse's best response is: A. "Don't worry about your hair loss. A good wig can disguise that." B. "No one knows how long it will take your hair to grow back. You'll have to learn to cope with its loss." C. "A little hair loss shouldn't concern you. You have more serious things to worry about." D. "Your hair loss will be temporary. Would you like to tell me about your concerns?" - D. "Your hair loss will be temporary. Would you like to tell me about your concerns?" Alopecia, which can occur with the administration of some chemotherapeutic agents, is psychologically disturbing for many clients even though the loss is temporary. Clients should be reassured that their hair will grow back. The nurse should encourage the client to discuss any concerns and should explore the various options available to the client (e.g., caps, wigs, scarves, turbans). Telling the client not to worry about hair loss or that there are more serious worries trivializes the client's concerns. Telling the client to learn to cope with hair loss conveys negativity and harsh judgment and is likely to demoralize the client. A client with a modified radical mastectomy is being discharged. The client has been very reluctant to discuss the surgery or her situation. The nurse making assignments should delegate the client's care to the: A. unlicensed assistive personnel (UAP) because the client is stable and being discharged. B. same nurse who has cared for her the past 3 days, for continuity of care. C. nurse in orientation who needs experience in discharge instructions. D. nurse with the most bed baths, because this client will not need a bath. - B. same nurse who has cared for her the past 3 days, for continuity of care. Continuity of care is crucial for this client to feel more comfortable about asking questions and discussing her care at home. A UAP does not have the educational preparation (registered nursing license) to provide discharge instructions. It is not appropriate to assign this client to a nurse in orientation or one who needs assistance; the priority need is continuity of care. Which outcome is expected of a nursing referral to a cancer support group? The client can: A. choose the best treatment options. B. find financial help. C. obtain home health care. D. cope with cancer. - D. cope with cancer. Support groups are designed to educate clients and their families experiencing cancer about the disease and methods of coping positively with it. These are selfhelp and support groups monitored by professionals and cancer survivors who have undergone a training course that helps them to facilitate small groups. The family of an older adult with terminal cancer asks about having hospice services. What should the nurse tell the family? Hospice care: A. focuses only on the needs of the client. B. can only be provided in the inpatient setting. C. is staffed exclusively by professional health care workers. D. focuses on supportive care for the client and family. - D. focuses on supportive care for the client and family. Hospice care focuses on supportive care for the client and family. Care for the family may continue throughout the bereavement period. Hospice care involves care of the client at home as well as in an inpatient setting. Although professional care is provided in hospice, family members, volunteers, and unlicensed nursing personnel (UAP) also participate in the care of the client. The nurse teaches the client with chronic cancer pain about optimal pain control. Which recommendation is most effective for pain control? A. Get used to some pain, and use a little less medication than needed to keep from being addicted. B. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain. C. Take analgesics only when pain returns. D. Take enough analgesics around the clock so that you can sleep 12 to 16 hours a day to block the pain. - B. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain. 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. Which strategy will be most effective in improving transcultural communications with oncology clients and their families? A. Use touch to show concern and caring for the client. B. Focus attention on verbal communication skills only. C. Establish a rapport and listen to their concerns. D. Maintain eye contact at all times. - C. Establish a rapport and listen to their concerns. 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. he nurse is teaching the client who is receiving chemotherapy and the family how to manage possible nausea and vomiting at home. What information should the nurse include in the teaching plan? A. Eating frequent, small meals. B. Include soft foods in the diet. C. Drink a milkshake made with fruit every day. D. Limit the amount of fluid intake. - A. Eating frequent, small meals. To reduce the adverse effects of chemotherapy such as nausea and vomiting, the nurse can suggest that the client eat small meals more frequently, which will be better tolerated while maintaining adequate nutrition. It is not necessary to eat soft food or milkshakes blended with fruit. Fluid intake should be encouraged to avoid dehydration. 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 a thorough examination, there is no new evidence of increased disease, yet the pain is close to 8 again. What is the most likely explanation for the increasing pain? A. development of an addiction to the opioids B. tolerance to the opioid C. withdrawal from the opioid D. placebo effect has decreased - B. tolerance to the opioid 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. A nurse is conducting a cancer risk screening program. Which client is at greatest risk for skin cancer? A. 45-year-old health care worker B. 15-year-old high school student C. 30-year-old butcher D. 60-year-old mountain biker - D. 60-year-old mountain biker 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. A client with brown hair is concerned about losing hair as a result of chemotherapy. What should the nurse tell the client? A. "The new growth of hair will be gray." B. "The hair loss is temporary." C. "New hair growth will always be the same texture and color as it was before chemotherapy." D. "Avoid use of wigs when possible." - B. "The hair loss is temporary." 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. The nurse is witnessing the client's signature on the informed surgical consent for an abdominal hysterectomy. The nurse should be certain the client understands that what will be the outcome of this surgery? A. decreased libido. B. infertility. C. depression. D. weight gain. - B. infertility. The client needs to understand that with removal of the uterus she will no longer be able to bear children or have menstrual periods. The surgical procedure should not change her libido or sexual functioning. Research does not support the idea that hysterectomy contributes to depression or weight gain. Research demonstrates that women who have managed health problems for some time before the hysterectomy may actually have a more positive effect, with less worry about their health condition, contraception, or pregnancy. A nurse is caring for a client who had a prostatectomy for prostate cancer. The nurse is reviewing the client's vital signs and intake and output as documented by a nursing assistant. (BP: 110/64, HR: 78, RR: 14, T: 99.4, Intake: 1420mL, Output: 330mL) Which documented finding requires immediate action? A. blood pressure B. heart rate C. intake and output D. temperature - C. intake and output The client has a significantly greater intake than output. This finding may indicate that the catheter is blocked and causing urine retention. The nurse should immediately irrigate the catheter and try to determine if clots are blocking the catheter. If the nurse is unable to irrigate the catheter, the healthcare provider should be notified immediately. The client's heart rate and blood pressure are normal. Although the temperature is slightly elevated, this finding is not a priority at this time. A client with stage II ovarian cancer undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. During the second postoperative day, which assessment finding requires immediate intervention? A. abdominal pain B. hypoactive bowel sounds C. serous drainage from the incision D. shallow breathing and increasing lethargy - D. shallow breathing and increasing lethargy Shallow breathing and a change in the level of consciousness, such as increasing lethargy requires immediate intervention because they may indicate a respiratory complication — for example, atelectasis or carbon dioxide retention. To avoid respiratory complications, the nurse should encourage turning, coughing, deep breathing, and ambulation during the early postoperative period. Abdominal pain, hypoactive bowel sounds, and serous drainage from the incision are expected findings during the first few days after this type of surgery. A client asks the nurse what PSA is. The nurse should reply that it stands for A. prostate-specific antigen, which is used to screen for prostate cancer. B. protein serum antigen, which is used to determine protein levels. C. pneumococcal strep antigen, which is a bacteria that causes pneumonia. D. papanicolaou-specific antigen, which is used to screen for cervical cancer. - A. prostate-specific antigen, which is used to screen for prostate cancer. PSA stands for prostate-specific antigen, which is used to screen for prostate cancer. A client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the right arm, and the client's left arm and hand should be elevated as much as possible to prevent: A. carpal tunnel syndrome. B. peripheral neuropathy. C. contractures. D. lymphedema. - D. lymphedema. Lymphedema is a common postoperative effect of modified radical mastectomy and lymph node dissection. Elevation of the left arm and hand will allow gravity to assist lymph drainage. Other preventive measures include exercises in which the arms are elevated. Peripheral neuropathy is not associated with postoperative complications, nor are contractures. Although muscle atrophy is a potential adverse effect if the client does not exercise the left arm, it would not be prevented by elevation. The nurse is speaking to a group of women about early detection of breast cancer. Which screening does the nurse recommend to women age 50 and older? A. annual self breast examination B. annual mammogram C. annual test for hormonal receptor assay D. biennial clinical breast examination by a healthcare provider - B. annual mammogram The Canadian Cancer Society states at 50 years that women should have a mammogram annually and a clinical examination at least annually (not every 2 years). The American Cancer Society recommends mammography yearly beginning at age 40. All women should perform breast self-examination monthly (not annually). The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen or progesterone dependent. An annual breast exam by a healthcare provider should be performed. The nurse is conducting a health history for a client at risk for cancer. Which lifestyle factor is considered a risk for colorectal cancer? A. a diet low in vitamin C B. a high dietary intake of artificial sweeteners C. a high-fat, low-fiber diet D. multiple sex partners - C. a high-fat, low-fiber diet 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. A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (Canadian Cancer Society) guidelines, the nurse should recommend that the women A. perform breast self-examination annually. B. have a mammogram annually. C. have a hormonal receptor assay annually. D. have a physician conduct a clinical examination every 2 years. - B. have a mammogram annually. The American Cancer Society (Canadian Cancer Society) guidelines state that women age 40 and older should have a mammogram annually and a clinical examination at least annually (not every 2 years). All women should perform breast self-examination monthly (not annually). The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesteronedependent. A nurse is caring for a client who is receiving chemotherapy for lung cancer. During the hand-off report, the nurse from the previous shift states that the client has been placed on neutropenic precautions. Which laboratory value supports this nursing action? A. a red blood cell count of 3.5 million/mm3 B. a platelet count of 90,000 per microliter C. a retculocyte count of 1% D. a white blood cell count of 2200/mm3 - D. a white blood cell count of 2200/mm3 The normal number of WBCs in the blood is 4,500-10,000 white blood cells per microliter (mcL). Less than 4,500 is considered neutropenia and places the client at risk for infection. The platelet count ranges from 150,000 to 450,000/mcL. Platelets are responsible for blood clotting. The nurse needs to institute bleeding precautions for this, not neutropenic precautions. Red blood cells are responsible for oxygen transport. The reticulocyte count is normal. The care of which client can be assigned to an unlicensed assistive personnel (UAP)? A. a client with stomatitis who requires instruction about mouth care before discharge B. a client who is having radiation for cancer of the stomach and is to have the radiation site bathed with warm water, followed by an application of a moisturizer C. a client who had a gastric resection and has a nasogastric tube draining bright red blood D. a client who had abdominal surgery and requires wet-to-dry dressing changes - B. a client who is having radiation for cancer of the stomach and is to have the radiation site bathed with warm water, followed by an application of a moisturizer The care of the client who is having radiation treatments and requires skin care at the site that involves bathing and application of a nonmedicated moisturizer is within the scope of practice for the UAP. Discharge planning, assessing drainage, and changing wet-to-dry dressings are nursing care activities that must be performed by a licensed nurse. A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which assessment made after the procedure would indicate the development of a potential complication? A. The client has a sore throat. B. The client displays signs of sedation. C. The client experiences a sudden increase in temperature. D. The client demonstrates a lack of appetite. - C. The client experiences a sudden increase in temperature. The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike within 1 to 2 hours after the procedure is indicative of a perforation and should be reported immediately to the health care provider. A sore throat is to be anticipated after an endoscopy. Clients are given sedatives during the procedure, so it is expected that they will display signs of sedation after the procedure is completed. A lack of appetite could be the result of many factors, including the disease process. Which expected outcome about nutrition would be appropriate for a client who has had a total gastrectomy for gastric cancer? The client will: A. regain any weight lost within 4 weeks of the surgical procedure. B. eat three full meals a day without experiencing gastric complications. C. learn to self-administer enteral feedings every 4 hours. D. maintain adequate nutrition through oral or parenteral feedings. - D. maintain adequate nutrition through oral or parenteral feedings. An appropriate expected outcome is for the client to maintain nutrition either through oral or total parenteral feedings. Oral and total parenteral nutrition may also be used concurrently. It is not realistic to expect the client to regain weight loss within 4 weeks of surgery. After surgery, it is recommended that the client eat six small meals a day rather than three full meals to decrease symptoms of dumping syndrome. Enteral feedings are not part of the expected outcome for gastric surgery. A client with colon cancer is having a barium enema. The nurse should instruct the client to take which type of medication after the procedure is completed? A. laxative B. anticholinergic C. antacid D. demulcent - A. laxative After a barium enema, a laxative is ordinarily prescribed. This is done to promote elimination of the barium. Retained barium predisposes the client to constipation and fecal impaction. Anticholinergic drugs decrease gastrointestinal motility. Antacids decrease gastric acid secretion. Demulcents soothe mucous membranes of the gastrointestinal tract and are used to treat diarrhea. A nurse is interviewing a client about their past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? A. duodenal ulcers B. hemorrhoids C. weight gain D. polyps - D. polyps Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer. A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? A. Test all stools for occult blood. B. Administer topical ointment to the rectal area to decrease bleeding. C. Prepare the client for a gastrostomy tube placement. D. Administer morphine routinely, as ordered. - A. Test all stools for occult blood. Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed Which client is at highest risk for colorectal cancer? A. the client who smoked 1 pack a day for 30 years B. the client who follows a vegetarian diet C. the client who has been treated for Crohn's disease for 20 years D. the client with a family history of lung cancer - C. the client who has been treated for Crohn's disease for 20 years 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. A client is being discharged after abdominal surgery and colostomy formation to treat colon cancer. Which nursing action is most likely to promote continuity of care? A. notifying the American Cancer Society (Canadian Cancer Society) of the client's diagnosis B. advocating for the client by ordering Meals on Wheels 5 days a week C. asking the physician to write an order for home skilled nursing assessments and interventions D. asking an occupational therapist to evaluate the client at home - C. asking the physician to write an order for home skilled nursing assessments and interventions Many clients are discharged from acute care settings so quickly that they don't receive complete instructions. Therefore, the first priority is to arrange for home healthcare. The American Cancer Society (Canadian Cancer Society) often sponsors support groups, which are helpful when the person is ready. However, contacting this organization would break client confidentiality, and even with the client's consent does not take precedence over ensuring proper home healthcare. Advocating for Meals On Wheels and asking for an occupational therapy evaluation are important, but these actions can occur later in rehabilitation. When caring for a client with nonresectable colon cancer, which nursing diagnosis requires the nurse to function collaboratively to achieve the best outcome related to client comfort? A. Risk for deficient fluid volume B. Acute pain C. Activity intolerance D. Imbalanced nutrition: Less than body requirements - B. Acute pain A nurse must collaborate with a physician to achieve the best pain control for the client. A nurse may not give medications, such as analgesics and antibiotics, without a physician order, and the nurse assesses the client's response to pain medications and provides feedback to the physician. The nurse may assist the client with nonpharmacologic activities for pain control. The nurse may implement independent nursing interventions, such as performing assessments, providing appealing fluids, pacing nursing care to promote rest and minimize client fatigue, and providing small frequent meals to address Risk for imbalanced fluid volume, Activity intolerance, and Imbalanced nutrition. A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member? A. social worker B. staff nurse C. clinical educator D. enterostomal nurse - D. enterostomal nurse The surgeon should collaborate with the enterostomal nurse, who can address the client's concerns. The enterostomal nurse may schedule a visit with a client who has a colostomy to offer support to the client. The clinical educator can provide information about the colostomy when the client is ready to learn. The staff nurse and social worker aren't specialized in colostomy care, so they aren't the best choices for this situation. The nurse should teach clients about which potential risk factor for the development of colon cancer? A. chronic constipation B. long-term use of laxatives C. history of smoking D. history of inflammatory bowel disease - D. history of inflammatory bowel disease A history of inflammatory bowel disease is a risk factor for colon cancer. Other risk factors include age (older than 40 years), history of familial polyposis, colorectal polyps, and high-fat or low-fiber diet. A client is receiving monthly doses of chemotherapy for treatment of stage III colon cancer. Which laboratory results should the nurse report to the oncologist before the next dose of chemotherapy is administered? Select all that apply. A. hemoglobin of 14.5 g/dL (145 g/L) B. platelet count of 40,000/mm3 (40 X 109/L) C. blood urea nitrogen (BUN) level of 12 mg/dL (4.3 mmol/L) D. white blood cell count of 2,300/mm3 (2.3 X 109/L) E. temperature of 101.2° F (38.4° C) F. urine specific gravity of 1.020 - B. platelet count of 40,000/mm3 (40 X 109/L) D. white blood cell count of 2,300/mm3 (2.3 X 109/L) E. temperature of 101.2° F (38.4° C) Chemotherapy causes bone marrow suppression and risk of infection. A platelet count of 40,000/mm3 (40 X 109/L) and a white blood cell count of 2,300/mm3 (2.3 X 109/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. Which statement indicates that a client understands the need for routine screening to detect colorectal cancer? A. "I need to have a colonoscopy at age 45 then every 10 years until age 75." B. "I will submit a stool sample for occult blood at age 50 and then yearly until age 75." C. "I will have a flexible sigmoidoscopy at age 45 and then every 10 years until age 70." D. "I need to have a stool DNA test at age 50 and repeat every 3 years." - A. "I need to have a colonoscopy at age 45 then every 10 years until age 75." The American Cancer Society (Canadian Cancer Society and Health Canada) recommends that starting at age 45, individuals of average risk undergo regular screening with one of six different tests and that screening happens through age 75. Colonoscopy should be repeated every 10 years. Fecal occult blood test (FOBT) should be repeated every year. Flexible sigmoidoscopy is recommended every 5 years. A stool DNA test is repeated every 3 years. The recommendations do not prioritize one test over another. Which action is most important when the nurse is planning pain management for a client after a lobectomy for lung cancer? A. repositioning the client immediately after administering pain medication B. reassessing the client after administering pain medication C. reassuring the client after administering pain medication D. readjusting the pain medication dosage as needed - B. reassessing the client after administering pain medication It is essential for the nurse to evaluate the effects of pain medication after it has had time to act. Although other interventions may be appropriate, continual reassessment is most important to determine the effectiveness and need for additional intervention, if any. Repositioning could provide some comfort, but assessment of the client's pain level is essential. Reassuring the client is important, but it will be of no value unless the nurse evaluates the client's pain level. To readjust the pain dosage is appropriate only if titration is prescribed by the health care provider (HCP). A client had a right pneumonectomy for lung cancer yesterday and now has dyspnea. What position in bed will be best for this client? A. lying on the left side B. positioned for postural drainage C. head of bed elevated D. flat in bed on full bed rest - C. head of bed elevated The client will be most comfortable and have the best lung expansion with the head of the bed elevated. When in a side lying position, the client should lie on the right side to permit expansion of the unaffected lung. Postural drainage positioning will lower the head of bed and increase dyspnea. Lying flat will increase the dyspnea; the client should be encouraged to be out of bed as tolerated. After a lobectomy for lung cancer, the nurse instructs the client to perform deep breathing exercises. What is the expected outcome of these exercises? A. Decrease blood flow to the lungs for rest and increased surface alveoli ventilation. B. Elevate the diaphragm to enlarge the thorax so that the lung surface area available for gas exchange is increased. C. Control the rate of air flow to the remaining lobe to decrease the risk of hyperinflation. D. Expand the alveoli and increase lung surface available for ventilation. - D. Expand the alveoli and increase lung surface available for ventilation. Deep breathing helps prevent microatelectasis and pneumonitis and also helps force air and fluid out of the pleural space into the chest tubes. It does not decrease blood flow to the lungs or control the rate of air flow. The diaphragm is the major muscle of respiration; deep breathing causes it to descend, thereby increasing the ventilating surface. After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when the nurse notes tidal movements or fluctuations in which compartment of the system as the client breathes? A. water-seal chamber B. air-leak chamber C. collection chamber D. suction control chamber - A. water-seal chamber Fluctuations in the water-seal compartment are called tidal movements and indicate normal function of the system as the pressure in the tubing changes with the client's respirations. The air-leak meter — not chamber — detects air leaking from the pleural space. The collection chamber connects the chest tube from the client to the system. Drainage from the tube drains into and collects in a series of calibrated columns in this chamber. The suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest. A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis? A. seizure disorder B. chronic obstructive pulmonary disease (COPD) C. anemia D. bleeding disorder - D. bleeding disorder A bleeding disorder is a contraindication for thoracentesis because a hemorrhage may occur during or after this procedure, possibly causing death. Although a history of a seizure disorder, COPD, or anemia calls for caution, it doesn't contraindicate thoracentesis. 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 assessment for which symptom? A. ascites B. pleural friction rub C. dyspnea D. peripheral edema - C. dyspnea 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. The nurse on the previous night shift documented that the lungs of a client with lung cancer were CTA (clear to auscultation) in all fields. While doing the shift assessment, the day shift nurse noticed decreased breath sounds, especially in the right lower lobe. Which action is the nurse's best choice? A. Report the findings to the charge nurse for documentation follow up with the previous shift's nurse. B. Document the findings as the only action, as this is expected in clients with lung cancer. C. Notify the physician of the change in client status. D. Call radiology for an X-ray to confirm findings. - C. Notify the physician of the change in client status. Pleural effusion is a common complication of lung cancer. Fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished. Documentation of abnormal findings without any follow up is an error in the nursing process. Ordering an Xray is not an independent nursing action. A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan? A. avoiding using deodorant soap on the irradiated areas B. applying talcum powder to the irradiated areas daily after bathing C. wearing a lead apron during direct contact with the client D. removing thoracic skin markings after each radiation treatment - A. avoiding using deodorant soap on the irradiated areas Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water and a mild soap only and leave the area open to air. No deodorants or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed. What is a risk factor for women who have human papillomavirus (HPV)? A. sterility B. cervical cancer C. uterine fibroid tumors D. irregular menses - B. cervical cancer Women who have HPV are much more likely to develop cervical cancer than women who have never had the disease. Cervical cancer is now considered a sexually transmitted disease. Regular examinations, including Papanicolaou tests, are recommended to detect and treat cervical cancer at an early stage. Girls and women as well as boys and men (around ages 9 to 26 depending on the vaccine) should receive a vaccine to prevent HPV. HPV does not cause sterility, uterine fibroid tumors, or irregular menses. The nurse provides care to a client with anogenital warts. The nurse teaches that anogenital warts increase an adolescent female's risk of which condition? A. infertility B. cervical cancer C. dysmenorrhea D. urinary tract infections - B. cervical cancer Anogenital warts are associated with human papillomavirus (HPV) and increase an adolescent female's risk of cervical cancer. This risk mandates treatment of all external lesions. HPV doesn't increase the risk of infertility, infections, or painful menstrual cycles. A client with human papillomavirus (HPV) infection is being treated by a colposcopy. The client asks the nurse if this procedure is really necessary. The nurse can tell the client that if the HPV infection is not treated which health problem is likely to occur? A. infertility B. cervical cancer C. pelvic inflammatory disease D. rectal cancer - B. cervical cancer HPV infection, or genital warts, can lead to dysplastic changes of the cervix, referred to as cervical intraepithelial neoplasia. The development of cervical cancer remains the largest threat of all condyloma-associated neoplasias. Infertility, pelvic inflammatory disease, and rectal cancer are not complications of genital warts. Which nurse should be assigned to a client receiving brachytherapy for the treatment of cervical cancer? A. female nurse with 3 years' experience working in oncology B. male nurse who has floated to this unit from the operating room C. female nurse with 10 years' experience who suspects she may be pregnant D. male nurse who is also assigned to another client receiving brachytherapy - A. female nurse with 3 years' experience working in oncology Brachytherapy is internal radiation and nurses must use the principles of time, distance, and shielding. Radiation has cumulative effects and the nurse already working with a client receiving radiation should not be exposed to additional radiation. Working with clients who are receiving internal radiation takes a certain skill set, and the male nurse who has floated from the operating room is not the best person to work with this client. Radiation is harmful to the fetus, and the nurse who suspects she is pregnant should not be exposed to radiation 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, how should the nurse respond to the client? A. "All women experience sexual problems with this surgical procedure. Do you have any questions?" B. "When can I schedule an appointment with you and your partner to discuss any issues either of you may have regarding sexuality?" C. "Do you anticipate any problems with sex related to your scheduled hysterectomy?" D. "Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?" - D. "Most women have concerns about their sexuality after this type of surgery. Do you have any concerns or questions?" 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. A client with cervical cancer is undergoing internal radium implant therapy. A leadlined container and a pair of long forceps have been placed in the client's hospital room. What should the nurse tell the client about how these will be used? The forceps and container will be used for: A. disposal of emesis or other bodily secretions. B. handling of the dislodged radiation source. C. disposal of the client's eating utensils. D. storage of the radiation dose. - B. handling of the dislodged radiation source. Dislodged radioactive materials should not be touched with bare or gloved hands. Forceps are used to place the material in the lead-lined container, which shields the radiation. Exposure to radiation can occur only by direct exposure to the encased radioactive substance; it cannot result from contact with emesis or urine or from touching the client. Disposal of eating utensils cannot lead to radiation exposure. Radioactive dose materials are kept only in the radiation department. A 30-year-old client whose mother died of breast cancer at age 44 and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic? A. mammogram B. papanicolaou (Pap) testing every 6 months C. contacting the American Cancer Society (Canadian Cancer Society) D. genetic counseling - D. genetic counseling The nurse should suggest that the client ask the physician about genetic counseling. Genetic counseling is indicated for those at high risk because of family or personal cancer history. Genetic counseling involves obtaining a detailed medical and threegenerational family history; calculating a personalized risk assessment; providing options for prevention, surveillance, and genetic testing; coordinating and interpreting genetic testing; and developing a management plan based on the test results. Mammography will assist with early detection of most breast cancers, but it won't establish a risk assessment and provide options for prevention, surveillance, and genetic testing. Pap testing every 6 months assists in early detection of most cervical cancers, but it won't establish a risk assessment. Contacting the American Cancer Society (Canadian Cancer Society) won't help assess the client's risk for developing cancer. A woman tells the nurse, "There has been a lot of cancer in my family." The nurse should instruct the client to report which possible sign of cervical cancer? A. pain B. leg edema C. urinary and rectal symptoms D. light bleeding or watery vaginal discharge - D. light bleeding or watery vaginal discharge In its early stages, cancer of the cervix is usually asymptomatic, which underscores the importance of regular Pap smears. A light bleeding or serosanguineous discharge may be apparent as the first noticeable symptom. Pain, leg edema, urinary and rectal symptoms, and weight loss are late signs of cervical cancer. A client with suspected cervical cancer had a colposcopy with conization. What information should the nurse give the client about her menstrual periods after this surgery? A. Her periods will return to normal after 6 months. B. Her next two or three periods may be heavier and more prolonged than usual. C. Her next two or three periods will be lighter than normal. D. She may skip her next two periods. - B. Her next two or three periods may be heavier and more prolonged than usual. The client should be informed that her next two or three periods could be heavy and prolonged. The client is instructed to report any excessive bleeding. The nurse should reinforce the necessity for the follow-up check and the review of the biopsy results with the client. The client's periods will not be normal for 2 to 3 months. A client tells the nurse that her bra fits more snugly at certain times of the month and she is concerned this may be a sign of breast cancer. The nurse should give the client which information about this situation? A. A change in breast size should be checked by her health care provider (HCP). B. Benign cysts tend to cause the breast to vary in size. C. It is normal for the breast to increase in size before menstruation begins. D. A difference in the size of her breasts is related to normal growth and development. - C. It is normal for the breast to increase in size before menstruation begins. Normally, breasts are about the same size. They can vary in size before menstruation due to breast engorgement caused by hormonal changes. It is not necessary for a HCP to check this slight change in breast size. The changes in breast size this client described are most likely caused by hormonal changes, not a benign cyst or normal growth and development. A mastectomy is recommended for a 68-year-old client diagnosed with breast cancer a week ago. When approached about giving consent for the mastectomy, the client says, "What's the use in trying to get rid of the cancer? It will just come back! I can't handle another thing—having diabetes is enough. Besides, I'm getting old. It would be different if I were younger and had more energy." What should the nurse do? A. Accept the client's decision because it is her right to choose to obtain treatment or not. B. Give the client information about the survival rates for clients who underwent mastectomies. C. Call the chaplain to speak with the client about her hopeless attitude about the future. D. Explore with the client her feelings about her health problems and proposed surgery. - D. Explore with the client her feelings about her health problems and proposed surgery. While the client does have a right to accept or reject treatment, she has not explored her feelings, her possible mastectomy, or the future. The nurse should assist the client in exploring her feelings and moving toward a fuller understanding of her options. Giving the client survival rates indicates that the nurse feels she should have the surgery and negates her fears and concerns. While the chaplain might be helpful, this step should be done after the client has explored her feelings. A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? A. Urine output of 400 ml in 8 hours B. Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} C. Blood pressure of 120/64 to 130/72 mm Hg D. Sodium level of [142 mEq/L (142 mmol/L)] - B. Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.