Oncology

Front 1

A client with cancer verbalizes that he is afraid he won't be able to cope with all the issues that will arise. The nurse can best support the coping behaviors of a client with cancer by:

a) Encouraging compliance with treatment regimens.

b) Helping the client identify available resources.

c) Relieving the client of decision making as much as possible.

d) Assisting the client to prepare for adverse treatment effects.

Back 1

b) Helping the client identify available resources.

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.

Front 2

On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she:

a) should continue to perform breast self-examination on her right breast.

b) will have irregular menses.

c) is lucky that the cancer was caught in time.

d) should schedule a follow-up appointment in 6 months.

Back 2

a) should continue to perform breast self-examination on her right breast.

Having breast cancer on her left side puts the client more at risk for cancer on the opposite side and chest wall. Therefore, the nurse should stress the importance of monthly breast self-examinations and annual mammograms. Although the tumor was found, it was large enough to require a mastectomy, and could put the patient at risk for metastasis. Follow-up appointments should be monthly for the first few months and then scheduled at the direction of her health care provider. Modified radical mastectomy shouldn't affect the menstrual cycle.

Front 3

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) Removing thoracic skin markings after each radiation treatment

b) Applying talcum powder to the irradiated areas daily after bathing

c) Avoiding using deodorant soap on the irradiated areas

d) Wearing a lead apron during direct contact with the client

Back 3

c) 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.

Front 4

Which of the following goals is appropriate for a client with multiple myeloma?

a) Decrease episodes of nausea and vomiting.

b) Achieve effective management of bone pain.

c) Recover from the disease with minimal disabilities.

d) Avoid hyperkalemia.

Back 4

b) Achieve effective management of bone pain.

In multiple myeloma, neoplastic plasma cells invade the bone marrow and begin to destroy the bone. As a result of this skeletal destruction, pain can be significant. There is no cure for multiple myeloma. Nausea and vomiting are not characteristics of the disease, although the client may experience anorexia. The client should be monitored for signs of hypercalcemia resulting from bone destruction, not for hyperkalemia.

Front 5

A client is receiving external-beam radiation therapy to the thoracic and lumbar spine because of metastatic breast cancer. Which of the following people should be permitted to visit?

a) The client’s elderly sister, who has a history of chronic obstructive pulmonary disease and frequent respiratory infections

b) The client’s husband, who is recovering from the flu

c) The client’s grandson with his wife and four children, who are between the ages of 4 and 8 years

d) The client’s pregnant granddaughter

Back 5

d) The client’s pregnant granddaughter

The pregnant granddaughter is in no danger from external-beam radiation therapy, and the granddaughter would pose no health threat to the client. Anyone with possible communicable illnesses should not visit. A family with four children may pose a threat because of the large number of people visiting.

Front 6

The client asks the nurse to explain what it means that his Hodgkin's disease is diagnosed at stage 1A. What describes the involvement of the disease?

a) involvement of two or more lymph nodes on the same side of the diaphragm

b) involvement of lymph node regions on both sides of the diaphragm

c) involvement of a single lymph node

d) diffuse disease of one or more extra lymphatic organs

Back 6

c) involvement of a single lymph node

In the staging process, the designations A and B signify that symptoms were or were not present when Hodgkin’s disease was found, respectively. The Roman numerals I through IV indicate the extent and location of involvement of the disease. Stage I indicates involvement of a single lymph node; stage II, two or more lymph nodes on the same side of the diaphragm; stage III, lymph node regions on both sides of the diaphragm; and stage IV, diffuse disease of one or more extralymphatic organs.

Front 7

A client with metastatic brain cancer is admitted to the oncology floor. According to the Self-Determination Act of 1991 concerning the execution of an advance directive, the hospital is required to:

a) decide on a treatment plan if the client can't.

b) advise clients not to execute their advance directives because they limit treatment options.

c) inform the client or legal guardian of their rights to execute an advance directive.

d) respect individuals' moral rights.

Back 7

c) inform the client or legal guardian of their rights to execute an advance directive.

The client Self-Determination Act of 1991 requires all health care facilities to notify clients upon admission of their right to execute an advance directive. The facility's ethics committee can decide on a treatment plan if the client is unable and a health care power of attorney hasn't been appointed. Hospital employees aren't required by law to respect an individual's moral rights; however, the health care professional should respect the client's individual rights as part of his professional responsibility. Health care professionals are sometimes concerned that advance directives prevent treatment that might help the client. However, the hospital isn't required to advise clients not to execute their advance directive.

Front 8

After the physician explains the risks and benefits of a clinical trial to a client, the client agrees to participate. Later that day, the client requests clarification of the process involved in the clinical trial. As a member of the multidisciplinary team, how should the nurse respond?

a) Provide the information requested.

b) Tell the client that the information should come from the physician who first presented it to him.

c) Not provide the information because it's beyond the scope of nursing practice.

d) Encourage the client to withdraw from the trial.

Back 8

a) Provide the information requested.

As part of the multidisciplinary team, the nurse is empowered to assist the client to better understand the process, as long as the nurse has an understanding of the treatment plan. The nurse shouldn't discourage the client from participating in the research study. Providing information to the client about the clinical trial isn't beyond the scope of nursing practice. The information doesn't need to come from the physician who originally presented the material to the client.