Chapter 20: Concepts of Care for Patients
with Cancer
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client with a history of prostate cancer is in the clinic and reports new onset of
severe low back pain. What action by the nurse is most important?
a. Assess the client’s gait and balance.
b. Ask the client about the ease of urine flow.
c. Document the report completely.
d. Inquire about the client’s job risks.
ANS: A
This client has symptoms of spinal cord compression, which can be seen with prostate
cancer. This may affect both gait and balance and urinary function. For client safety,
assessing gait and balance is most important. Documentation would be complete. The
client may or may not have occupational risks for low back pain, but with his history
of prostate cancer, this would not be where the nurse starts investigating.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Cancer, Oncologic emergencies MSC: Client Needs
Category: Physiological Integrity: Physiological Adaptation
2. The nurse has taught a client with cancer ways to prevent infection. What statement by
the client indicates that more teaching is needed?
a. “I should take my temperature daily and when I don’t feel well.”
b. “I will discard perishable liquids after sitting out for over an hour.”
, c. “I won’t let anyone share any of my personal toiletries.”
d. “It’s alright for me to keep my pets and change the litter box.”
ANS: D
Clients should wash their hands after touching their pets and would not empty or
scoop the cat litter box. The other statements are appropriate for self-management.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Evaluation
KEY: Cancer, Health teaching MSC: Client Needs Category:
Health Promotion and Maintenance
3. A client with long-standing heart failure being treated for cancer has received a dose
of ondansetron for nausea. What action by the nurse is most important?
a. Assess the client for a headache or dizziness.
b. Request a prescription for cardiac monitoring
c. Instruct the client to change positions slowly.
d. Weigh the client daily before eating.
ANS: B
5-HT3 antagonists, such as ondansetron, can prolong the QT interval within the
cardiac conduction cycle. ECG monitoring is recommended in patients with
electrolyte abnormalities (e.g., hypokalemia or hypomagnesemia), heart failure,
bradyarrhythmias or patients taking other medications that can cause QT
prolongation. The nurse would contact the primary health care provider and request
cardiac monitoring. The nurse would assess the client for any other reported changes,
but this is not a critical safety factor. Weight is not related directly to this drug.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Cancer, Client safety MSC: Client Needs
Category: Physiological Integrity: Pharmacological and Parenteral Therapies
, 4. A nurse working with clients who experience alopecia knows that which is the best
method of helping clients manage the psychosocial impact of this problem?
a. Assisting the client to pre-plan for this event
b. Reassuring the client that alopecia is temporary
c. Teaching the client ways to protect the scalp
d. Telling the client that there are worse side effects
ANS: A
Alopecia does not occur for all clients who have cancer, but when it does, it can be
devastating. The best action by the nurse is to teach the client about the possibility and
to give the client multiple choices for preparing for this event. Not all clients will have
the same reaction, but some possible actions the client can take are buying a wig
ahead of time, buying attractive hats and scarves, and having a hairdresser modify a
wig to look like the client’s own hair. Teaching about scalp protection is important
but does not address the psychosocial impact. Reassuring the client that hair loss is
temporary and telling him or her that there are worse side effects are both patronizing
and do not give the client tools to manage this condition.
DIF: Applying TOP: Integrated Process: Caring KEY: Cancer,
Psychosocial response MSC: Client Needs Category: Psychosocial
Integrity
5. A client is admitted with superior vena cava syndrome. What action by the nurse is
most appropriate?
a. Administer a dose of allopurinol.
b. Assess the client’s serum potassium level.
c. Gently inquire about advance directives.
d. Prepare the client for emergency surgery.
ANS: C
Superior vena cava syndrome is often a late-stage manifestation. After the client is
stabilized and comfortable, the nurse would initiate a conversation about advance
with Cancer
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client with a history of prostate cancer is in the clinic and reports new onset of
severe low back pain. What action by the nurse is most important?
a. Assess the client’s gait and balance.
b. Ask the client about the ease of urine flow.
c. Document the report completely.
d. Inquire about the client’s job risks.
ANS: A
This client has symptoms of spinal cord compression, which can be seen with prostate
cancer. This may affect both gait and balance and urinary function. For client safety,
assessing gait and balance is most important. Documentation would be complete. The
client may or may not have occupational risks for low back pain, but with his history
of prostate cancer, this would not be where the nurse starts investigating.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Cancer, Oncologic emergencies MSC: Client Needs
Category: Physiological Integrity: Physiological Adaptation
2. The nurse has taught a client with cancer ways to prevent infection. What statement by
the client indicates that more teaching is needed?
a. “I should take my temperature daily and when I don’t feel well.”
b. “I will discard perishable liquids after sitting out for over an hour.”
, c. “I won’t let anyone share any of my personal toiletries.”
d. “It’s alright for me to keep my pets and change the litter box.”
ANS: D
Clients should wash their hands after touching their pets and would not empty or
scoop the cat litter box. The other statements are appropriate for self-management.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Evaluation
KEY: Cancer, Health teaching MSC: Client Needs Category:
Health Promotion and Maintenance
3. A client with long-standing heart failure being treated for cancer has received a dose
of ondansetron for nausea. What action by the nurse is most important?
a. Assess the client for a headache or dizziness.
b. Request a prescription for cardiac monitoring
c. Instruct the client to change positions slowly.
d. Weigh the client daily before eating.
ANS: B
5-HT3 antagonists, such as ondansetron, can prolong the QT interval within the
cardiac conduction cycle. ECG monitoring is recommended in patients with
electrolyte abnormalities (e.g., hypokalemia or hypomagnesemia), heart failure,
bradyarrhythmias or patients taking other medications that can cause QT
prolongation. The nurse would contact the primary health care provider and request
cardiac monitoring. The nurse would assess the client for any other reported changes,
but this is not a critical safety factor. Weight is not related directly to this drug.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Cancer, Client safety MSC: Client Needs
Category: Physiological Integrity: Pharmacological and Parenteral Therapies
, 4. A nurse working with clients who experience alopecia knows that which is the best
method of helping clients manage the psychosocial impact of this problem?
a. Assisting the client to pre-plan for this event
b. Reassuring the client that alopecia is temporary
c. Teaching the client ways to protect the scalp
d. Telling the client that there are worse side effects
ANS: A
Alopecia does not occur for all clients who have cancer, but when it does, it can be
devastating. The best action by the nurse is to teach the client about the possibility and
to give the client multiple choices for preparing for this event. Not all clients will have
the same reaction, but some possible actions the client can take are buying a wig
ahead of time, buying attractive hats and scarves, and having a hairdresser modify a
wig to look like the client’s own hair. Teaching about scalp protection is important
but does not address the psychosocial impact. Reassuring the client that hair loss is
temporary and telling him or her that there are worse side effects are both patronizing
and do not give the client tools to manage this condition.
DIF: Applying TOP: Integrated Process: Caring KEY: Cancer,
Psychosocial response MSC: Client Needs Category: Psychosocial
Integrity
5. A client is admitted with superior vena cava syndrome. What action by the nurse is
most appropriate?
a. Administer a dose of allopurinol.
b. Assess the client’s serum potassium level.
c. Gently inquire about advance directives.
d. Prepare the client for emergency surgery.
ANS: C
Superior vena cava syndrome is often a late-stage manifestation. After the client is
stabilized and comfortable, the nurse would initiate a conversation about advance
