Chapter 16 Med Surge

Chapter: Chapter 16: Oncology: Nursing Management in Cancer Care
Multiple Choice
1. The school health nurse is presenting a health-promotion class to a group of middle-school
students. Which is the best interention to address health-promotion strategies related to the
leading cause of cancer deaths in North !merica"
!# Monthly self-breast e$ams
%# &mo'ing cessation
C# !nnual colonoscopies
(# Monthly testicular e$ams
!ns: %
Chapter: 16
Client Needs: %
Cognitie )eel: !nalysis
(ifficulty: Moderate
*ntegrated +rocess: Teaching,)earning
Ob-ectie: .
+age and /eader: 0012 3pidemiology of Cancer
4eedbac': Cancer is second only to cardioascular disease as a leading cause of death in the
5nited &tates. !lthough the numbers of cancer deaths hae decreased slightly2 more than
6672777 !mericans 8ere e$pected to die from a malignant process in 977:. The leading causes
of cancer death in the 5nited &tates2 in order of fre;uency2 are lung2 prostate2 and colorectal
cancer in men and lung2 breast2 and colorectal cancer in 8omen2 so smo'ing cessation is the
health promotion initiatie directly related to lung cancer. Therefore2 the other options are
incorrect.
9. <ou are the clinic nurse in an oncology clinic. <our patient arries for a 9-month follo8-up
appointment follo8ing chemotherapy. <ou note that the patient=s s'in appears yello8. Which
blood tests should be done to further e$plore this clinical sign"
!# )ier function test
%# C%C
C# +latelet count
(# 3lectrolytes
!ns: !
Chapter: 16
Client Needs: (-.
*ntegrated +rocess: Nursing +rocess
Ob-ectie: 1
+age and /eader: 0>12 Cancer &uriorship
4eedbac': &ureillance for cancer spread2 recurrence2 or second cancers: colonoscopy post
colon cancer2 mammography post breast cancer2 )ier function tests post colon cancer2 prostate-
specific antigen post prostate cancer. <ello8 s'in is a sign of -aundice. The lier is a common
organ affected by metastatic disease. ! lier function test should be done to determine if the lier
is functioning. Option % is incorrect? a C%C 8ould sho8 an altered 8hite blood cell count
indicating possible infection. Option C is incorrect? a platelet count tells 8hether the blood
sample has an ade;uate number of platelets2 necessary for blood clotting. Option ( is incorrect? a
blood test for electrolytes 8ould not identify the cause of the -aundice.
0. <ou are teaching a nutrition class in the local high school. One student tells you that he has
heard that certain foods can increase the incidence of cancer. <ou respond2 @Aesearch has sho8n
that certain foods appear to increase the ris' of cancer.B Which of the follo8ing menu selections
8ould be the best choice for reducing the ris's of cancer"
!# &mo'ed salmon and green beans
%# +or' chops and fried green tomatoes
C# %a'ed apricot chic'en and steamed broccoli
(# )ier2 onions2 and steamed peas
!ns: C
Chapter: 16
Client Needs: %
Cognitie )eel: !pplication
Ob-ectie: 0
+age and /eader: 0.12 +athophysiology of the Malignant +rocess
4eedbac': /igh-fiber foods? cruciferous egetables2 such as broccoli2 cauliflo8er2 and spinach?
and carotenoids2 such as apricots and peaches2 appear to reduce cancer ris'. &alt-cured foods2
such as ham and processed luncheon meats2 should be aoided. Options % and ( are incorrect as
they do not contain cruciferous egetables.
.. Traditionally2 nurses hae been inoled 8ith tertiary preention 8ith their cancer patients.
/o8eer2 emphasis is also placed on both primary and secondary preention. What 8ould be an
e$ample of primary preention"
!# <early +apanicolaou tests
%# Testicular self-e$amination
C# Teaching patients to 8ear sunscreen
(# &creening mammogram
!ns: C
Chapter: 16
Client Needs: %
Ob-ectie: .
+age and /eader: 0.02 (etection and +reention of Cancer
4eedbac': +rimary preention is concerned 8ith reducing the ris's of cancer in healthy people
through practices such as use of sunscreen. &econdary preention inoles detection and
screening to achiee early diagnosis2 as demonstrated by +apanicolaou tests2 mammograms2 and
testicular e$ams.
6. <ou are caring for a 0>-year-old 8oman 8ith a family history of breast cancer. &he has
re;uested a breast tumor mar'ing test and the results are positie. The patient is re;uesting a
bilateral mastectomy. What is this surgery an e$ample of"
!# &alage surgery
%# +alliatie surgery
C# +rophylactic surgery
(# Aeconstructie surgery
!ns: C
Chapter: 16
Client Needs: (-0
(ifficulty: (ifficult
Ob-ectie: 6
+age and /eader: 0.:2 Management of Cancer
4eedbac': +rophylactic surgery is used 8hen there is an e$tensie family history and nonital
tissues are remoed. &alage surgery is an additional treatment option that uses an e$tensie
surgical approach to treat the local recurrence of a cancer after the use of a less e$tensie primary
approach. +alliatie surgery is performed in an attempt to reliee complications of cancer2 such
as ulceration2 obstruction2 hemorrhage2 pain2 and malignant effusion. Aeconstructie surgery may
follo8 curatie or radical surgery in an attempt to improe function or obtain a more desirable
cosmetic effect.
6. <ou are caring for a patient 8ho is to begin receiing e$ternal radiation for a malignant tumor
of the head and nec'. While doing patient education2 8hat side effects should the nurse discuss
8ith the patient that should be assessed because of the radiation treatment"
!# *mpaired nutritional status
%# +in' oral mucosa
C# (iarrhea
(# !lopecia
!ns: !
Chapter: 16
Client Needs: (-.
Ob-ectie: 6
+age and /eader: 0612 Management of Cancer
4eedbac': !lterations in oral mucosa2 change and loss of taste2 pain2 and dysphasia often occur
as a result of radiotherapy to the head and nec'. The patient is at an increased ris' of impaired
nutritional status. Option % is incorrect? the oral mucosa is normally pin'. Options C and ( are
incorrect? diarrhea and alopecia are not concerns for this patient.
1. While a patient is receiing intraenous do$orubicin hydrochloride2 the nurse obseres that
there is s8elling and pain at the *C site. The nurse should
!# stop the administration of the drug immediately.
%# notify the patient=s physician.
C# continue to administer but decrease the rate of infusion.
(# apply a 8arm compress to the site.
!ns: !
Chapter: 16
Client Needs: (-9
Ob-ectie: 1
4eedbac': (o$orubicin hydrochloride is a chemotherapeutic essicant that can cause seere
tissue damage. The nurse should stop the administration of the drug immediately and then notify
the patient=s physician. *ce can be applied to the site once the drug therapy has stopped.
:. ! patient ne8ly diagnosed 8ith cancer is scheduled to begin chemotherapy treatment. The
patient as's the nurse 8hat the most common side effect of chemotherapy is. What 8ould be the
best ans8er the nurse could gie"
!# !lopecia
%# Nausea and omiting
C# !ltered glucose metabolism
(# *ncreased appetite
!ns: %
Chapter: 16
Client Needs: (-9
Ob-ectie: 1
4eedbac': Nausea and omiting are the most common side effects of chemotherapy and may
persist for as long as 9. to .: hours after its administration. !ntiemetic drugs are fre;uently
prescribed for these patients. Other side effects include bone marro8 suppression2 anore$ia2
aginal dryness2 and hair loss. )ess common effects include altered glucose metabolism and
-aundice.
>. <our patient is receiing carmustine2 a chemotherapy agent. ! significant side effect of this
medication is thrombocytopenia. Which symptom 8ould the nurse assess for in patients at ris'
for thrombocytopenia"
!# *nterrupted sleep pattern
%# /ot flashes
C# Nose bleed
(# *ncreased 8eight
!ns: C
Chapter: 16
Client Needs: (-.
Ob-ectie: 1
4eedbac': +atients 8ith thrombocytopenia are at ris' for bleeding due to decreased platelet
counts. ! priority goal for this patient is to preent trauma related to decreased platelet count. !
soft toothbrush or an electric raDor can be used. No inasie procedures should be performed.
+atients 8ith thrombocytopenia do not e$hibit interrupted sleep pattern2 hot flashes2 or increased
8eight.
17. <ou are orienting a ne8 nurse to the oncology unit 8here you 8or'. !s you prepare to
administer an antineoplastic agent to a one of your patients2 8hat should you teach the ne8 nurse
about antineoplastic agents"
!# !dminister only prepac'aged agents from the manufacturer
%# Wash hands and arms follo8ing administration
C# 5se gloes and a lab coat
(# (ispose of the antineoplastic 8astes in the haDardous 8aste receptacle
!ns: (
Chapter: 16
Client Needs: !-9
Ob-ectie: 1
4eedbac': The nurse should use surgical gloes and disposable long-sleeed go8ns 8hen
administering antineoplastic agents. The antineoplastic 8astes are disposed of as haDardous
materials. Option ! is incorrect? you do not administer only prepac'aged agents from the
manufacturer. Option % is incorrect? this is a alid ans8er2 but you 8ash your hands and arms
before and after administering the medication.
11. <ou are a nurse 8or'ing on a bone marro8 transplant unit. <our patient is scheduled to
receie a bone marro8 transplant. What information 8ill you proide to the patient=s isitors"
!# %ring plants to improe air ;uality.
%# Ta'e the patient to the cafeteria for meals.
C# Wear hospital scrubs 8hen entering the patient=s room.
(# (o not isit if you=e had a recent infection.
!ns: (
Chapter: 16
Client Needs: !-9
Ob-ectie: 6
4eedbac': %efore engraphment2 patients are at a high ris' for infection2 sepsis2 and bleeding.
Cisitors should not isit if they=e had a recent illness or accination. +lants should not be
brought to the %MT patient. The patient cannot go to the cafeteria for meals. (isposable hospital
go8ns are 8orn 8hen entering the patient=s room.
19. The nursing instructor is teaching a class in oncology nursing to her -unior nursing students.
The instructor is a8are that infection is a significant consideration 8hen proiding care to an
oncology patient. The leading cause of death in an oncology patient is infection caused by 8hat"
!# Malnutrition
%# *mpaired s'in integrity
C# +oor hygiene
(# %ro'en oral mucosa
!ns: %
Chapter: 16
Client Needs: !-9
Ob-ectie: 1
+age and /eader: 0112 Nursing Care of +atients 8ith Cancer
4eedbac': Nursing care for patients 8ith s'in reactions includes maintaining s'in integrity2
cleansing the s'in2 promoting comfort2 reducing pain2 preenting additional trauma2 and
preenting and managing infection. Option ! is incorrect? malnutrition in oncology patients may
be present2 but it is not the leading cause of death. Option C is incorrect? oncology patients do
not hae poor hygiene at a rate any higher than other patients2 and it does not cause death. Option
( is incorrect? bro'en oral mucosa may be an aenue for infection2 but it is not the leading cause
of death in an oncology patient.
Multiple &election
10. <ou are the nurse caring for an adult patient 8ho has deeloped a mild oral yeast infection
follo8ing chemotherapy. What should you encourage the patient to do" EMar' all that apply.#
!# 5se a lip lubricant
%# &crub the tongue 8ith a firm-bristled toothbrush
C# 5se dental floss eery 9. hours
(# Ainse the mouth 8ith normal saline
3# 3at hot foods to aid in 'illing the yeast
!ns: !2 C2 (
Chapter: 16
Client Needs: (-1
Ob-ectie: 1
4eedbac': &tomatitis is an inflammation of the oral caity. The patient should be encouraged to
brush the teeth 8ith a soft toothbrush after meals2 use dental floss eery 9. hours2 rinse 8ith
normal saline2 and use a lip lubricant. Mouth8ashes and hot foods should be aoided.
Multiple Choice
1.. The nurse on a bone marro8 transplant unit is caring for a patient 8ith cancer 8ho is
preparing for engraphment for a bone marro8 transplant. What is a priority nursing diagnosis for
this patient"
!# 4atigue and actiity intolerance
%# !ltered nutrition: less than body re;uirements due to anore$ia
C# Ais' for infection related to altered immunologic response
(# %ody image disturbance related to 8eight loss and anore$ia
!ns: C
Chapter: 16
Client Needs: (-9
Ob-ectie: :
4eedbac': ! priority nursing diagnosis for this patient is ris' for infection related to altered
immunologic response. %ecause the patient=s immunity is suppressed2 he or she 8ill be at a high
ris' for infection. Options !2 %2 and ( all are alid nursing diagnoses2 but they are not as much
of a priority as is ris' for infection.
16. The nursing instructor is discussing the care of oncology patients 8ith her -unior nursing
students. The instructor presents this scenario: !n oncology patient deelops erythema follo8ing
radiation therapy. What should the nurse instruct the patient to do"
!# !pply ice to the area.
%# Feep the area cleanly shaen.
C# !pply petroleum ointment to the affected area.
(# !oid using soap on the area of treatment.
!ns: (
Chapter: 16
Client Needs: (-0
Ob-ectie: 6
+age and /eader: 06:2 Nursing Care of +atients 8ith Cancer
4eedbac': Care to the affected area must focus on preenting further s'in irritation2 drying2 and
damage. &oaps2 petroleum ointment2 and shaing the area could 8orsen the erythema. *ce is also
contraindicated.
16. <ou are caring for a patient has -ust been gien a 6-month prognosis. The patient states that
he 8ould li'e to die at home. The patient=s care needs are unable to be met in a home
enironment. What might you suggest as an alternatie"
!# (iscuss a referral for rehabilitation hospital
%# +anel the patient for a personal care home
C# (iscuss a referral for acute care
(# (iscuss a referral for hospice care
!ns: (
Chapter: 16
Client Needs: (-1
*ntegrated +rocess: Caring
Ob-ectie: 17
4eedbac': /ospice care can be proided in seeral settings. %ecause of the high cost associated
8ith free-standing hospices2 care is often deliered by coordinating serices proided by both
hospitals and the community. The primary goal of hospice care is to proide support to the
patient and family. +atients 8ho are referred to hospice care generally hae less than 6 months to
lie. Option ! is incorrect? a rehabilitation hospital is inappropriate at this time. Option % is
incorrect? this is a distracter for this test ;uestion. Option C is incorrect? again2 this is an
inappropriate referral for this patient.
11. The clinic nurse is caring for a .9-year-old male oncology patient. /e complains of e$treme
fatigue and 8ea'ness after his first 8ee' of radiation therapy. Which response by the nurse
8ould best reassure this patient"
!# @These symptoms usually result from radiation therapy? ho8eer2 8e 8ill continue to
monitor your laboratory and G-ray studies.B
%# @These symptoms are part of your disease and can=t be helped.B
C# @(on=t be concerned about these symptoms. 3erybody feels this 8ay after haing radiation
therapy.B
(# @This is a good sign. *t means that only the cancer cells are dying.B
!ns: !
Chapter: 16
Client Needs: (-.
Ob-ectie: 6
4eedbac': 4atigue and 8ea'ness result from radiation treatment and usually don=t represent
deterioration or disease progression. The symptoms associated 8ith radiation therapy usually
decrease after therapy ends. The symptoms may concern the patient and shouldn=t be belittled.
Aadiation destroys both cancerous and normal cells.
1:. ! 16-year-old female patient e$periences alopecia resulting from chemotherapy2 prompting
the nursing diagnoses of disturbed body image and situational lo8 self-esteem. What action by
the patient 8ould best indicate that the patient is meeting the goal of improed body image and
self-esteem"
!# The patient re;uests that her family bring her ma'eup and 8ig.
%# The patient begins to discuss the future 8ith her family.
C# The patient reports less disruption from pain and discomfort.
(# The patient cries openly 8hen discussing her disease.
!ns: !
Chapter: 16
Client Needs: C
Ob-ectie: 1
4eedbac': Ae;uesting her 8ig and ma'eup indicates that the patient 8ith alopecia is becoming
interested in loo'ing her best and that her body image and self-esteem may be improing. The
other options may indicate that other nursing goals are being met2 but they don=t assess improed
body image and self-esteem.
1>. !derse effects to chemotherapy are dealt 8ith by patients and their caregiers eery day.
What 8ould the nurse do to combat the most common aderse effects of chemotherapy"
!# !dminister an antiemetic
%# !dminister an antimetabolite
C# !dminister a tumor antibiotic
(# !dminister an anticoagulant
!ns: !
Chapter: 16
Client Needs: (-9
(ifficulty: 3asy
Ob-ectie: 1
4eedbac': !ntiemetics are used to treat nausea and omiting2 the most common aderse effects
of chemotherapy. !ntihistamines and certain steroids are also used to treat nausea and omiting.
!ntimetabolites and tumor antibiotics are classes of chemotherapeutic medications.
!nticoagulants slo8 blood clotting time2 thereby helping to preent thrombi and emboli.
97. ! 6:-year-old male patient has been hospitaliDed for a 8edge resection of the left lo8er lung
lobe after a routine chest $-ray sho8s carcinoma. The patient is an$ious and as's if he can
smo'e. Which statement by the nurse 8ould be most therapeutic"
!# @&mo'ing is the reason you=re here.B
%# @The doctor left orders for you not to smo'e.B
C# @<ou=re an$ious about the surgery. (o you see smo'ing as helping"B
(# @&mo'ing is OF right no82 but after your surgery it=s contraindicated.B
!ns: C
Chapter: 16
Client Needs: C
*ntegrated +rocess: Communication and (ocumentation
Ob-ectie: 0
+age and /eader: 0.>2 Management of Cancer
4eedbac': This ac'no8ledges the patient=s feelings and encourages him to assess his preious
behaior. Option ! belittles the patient. Option % does not address the patient=s an$iety. Option (
8ould be highly detrimental to this patient.
91. The nursing instructor is discussing the difference bet8een normal cells and cancer cells
8ith the prenursing class in pathophysiology. What 8ould the instructor cite as a characteristic of
a cancer cell"
!# Malignant cells contain more fibronectin.
%# The cell membrane of malignant cells also contains proteins called tumor-specific antigens.
C# Chromosomes are commonly found to be strong.
(# Nuclei of cancer cells are large and regularly shaped.
!ns: %
Chapter: 16
Client Needs: (-.
Cognitie )eel: Fno8ledge
Ob-ectie: 1
+age and /eader: 00:2 +athophysiology of the Malignant +rocess
4eedbac': The cell membranes are altered in cancer cells2 8hich affect fluid moement in and
out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific
antigens. Malignant cellular membranes also contain less fibronectin2 a cellular cement.
Typically2 nuclei of cancer cells are large and irregularly shaped Epleomorphism#. 4ragility of
chromosomes is commonly found 8hen cancer cells are analyDed.
99. The staff educator is giing a class on oncology nursing for a group of nurses ne8 to the
unit. What is the most common mechanism of metastasis of cancer cells"
!# /ematologic spread
%# )ymphatic circulation
C# *nasion
(# !ngiogenisis
!ns: %
Chapter: 16
Client Needs: (-.
Ob-ectie: 1
+age and /eader: 00>2 +athophysiology of the Malignant +rocess
4eedbac': )ymph and blood are 'ey mechanisms by 8hich cancer cells spread. )ymphatic
spread Ethe transport of tumor cells through the lymphatic circulation# is the most common
mechanism of metastasis.
Multiple &election
90. <ou are giing a report in your pathophysiology class. The sub-ect of your report is cancer
cells. *n differentiating bet8een benign and malignant cells2 8hat characteristics 8ould you cite"
EMar' all that apply.#
!# Aate of gro8th
%# !bility to cause death
C# &iDe of cells
(# Cell contents
3# !bility to spread
!ns: !2 %2 3
Chapter: 16
Client Needs: (-.
(ifficulty: 3asy
Ob-ectie: 9
4eedbac': %enign and malignant cells differ in many cellular gro8th characteristics2 including
the method and rate of gro8th2 ability to metastasiDe or spread2 general effects2 destruction of
tissue2 and ability to cause death. Cells come in many siDes2 both benign and malignant? option (
is incorrect? cell contents are basically the same but they act differently.
Multiple Choice
9.. The nursing instructor is discussing benign ersus malignant cells in the pathophysiology
class. What distinguishes malignant cells from benign cells of the same tissue type"
!# &lo8 rate of mitosis of cancer cells
%# +roteins in the cell membrane
C# &iDe of cells
(# &tability of cells
!ns: %
Chapter: 16
Client Needs: (-.
Cognitie )eel: Fno8ledge
(ifficulty: 3asy
Ob-ectie: 9
4eedbac': The cell membrane of malignant cells also contains proteins called tumor-specific
antigens Eeg2 carcinoembryonic antigen HC3!I and prostate-specific antigen H+&!I#2 8hich
deelop oer time as the cells become less differentiated Emature#. These proteins distinguish
malignant cells from benign cells of the same tissue type.
96. Malignant disease processes hae the ability to spread from one organ to another throughout
the body. What is one means malignant disease processes transfer cells from one place to
another"
!# !dhering to primary tumor cells
%# Causing mutation of cells of another organ
C# +hagocytiDing healthy cells
(# *nading host tissues
!ns: (
Chapter: 16
Client Needs: (-.
Cognitie )eel: Comprehension
(ifficulty: 3asy
Ob-ectie: 9
+age and /eader: 00>2 +athophysiology of the Malignant +rocess
4eedbac': *nasion2 8hich refers to the gro8th of the primary tumor into the surrounding host
tissues2 occurs in seeral 8ays. Malignant cells are less li'ely to adhere than are normal cells.
Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.
Multiple &election
96. <ou are doing an initial assessment of a patient ne8ly diagnosed 8ith cancer. The patient
tells you that he drin's about a ;uart of scotch eery eening. What types of cancer does this put
him at ris' for" EMar' all that apply.#
!# +ancreatic cancer
%# %rain cancer
C# %reast cancer
(# 3sophageal cancer
3# )ier cancer
!ns: C2 (2 3
Chapter: 16
Client Needs: (-.
Ob-ectie: 0
+age and /eader: 0.12 +athophysiology of the Malignant +rocess
4eedbac': (ietary substances that appear to increase the ris' of cancer include fats2 alcohol2
salt-cured or smo'ed meats2 nitrate- and nitrite-containing foods, and red and processed meats.
!lcohol increases the ris' of cancers of the mouth2 pharyn$2 laryn$2 esophagus2 lier2
colorectum2 and breast.
Multiple Choice
91. <ou are the clinic nurse caring for a patient 8hose grandmother2 mother2 and sister all had
breast cancer. &he has re;uested a screening test to determine her ris' of deeloping breast
cancer2 and it has come bac' positie. The patient as's you 8hat she can do to help preent
breast cancer from occurring. What 8ould be your best response"
!# @Aesearch has sho8n that eating a healthy diet can reduce your chance of breast cancer.B
%# @Aesearch has sho8n that ta'ing tamo$ifen can reduce your chance of breast cancer.B
C# @Aesearch has sho8n that e$ercising at least 07 minutes eery day can reduce your chance of
breast cancer.B
(# @Aesearch has sho8n that reducing your inta'e of red meat can reduce your chance of breast
cancer.B
!ns: %
Chapter: 16
Client Needs: %
Ob-ectie: .
4eedbac': )arge-scale breast cancer preention studies supported by the National Cancer
*nstitute ENC*# indicated that chemopreention 8ith the medication tamo$ifen can reduce the
incidence of breast cancer by 67J in 8omen at high ris' for breast cancer. Options !2 C2 and (
are good ans8ers2 but they are not the best ans8er.
9:. <ou are a part of a team of nurses that is deeloping an educational program entitled Cancer:
*ts Ais's and What <ou Can (o !bout *t. This program is an e$ample of 8hat"
!# +rimary preention
%# Ais' reduction
C# &econdary preention
(# Tertiary preention
!ns: C
Chapter: 16
Client Needs: %
Ob-ectie: .
4eedbac': Nurses in all settings can deelop programs that identify ris's for patients and
families and that incorporate teaching and counseling into all educational efforts2 particularly for
patients and families 8ith a high incidence of cancer. +rimary preention is concerned 8ith
reducing the ris's of disease through health promotion strategies. Tertiary preention is the care
and rehabilitation of the patient after haing been diagnosed 8ith cancer. Option % is incorrect?
the program itself does not reduce the ris' of cancer.
9>. What is a minimally inasie surgical approach that is diagnostic for cancer and has2 in some
instances2 replaced lymph node dissections"
!# )ymphadenectomy
%# Needle biopsy
C# Open biopsy
(# &entinel lymph node biopsy
!ns: (
Chapter: 16
Client Needs: (-.
Ob-ectie: 6
+age and /eader: 0.62 Management of Cancer
4eedbac': &entinel lymph node biopsy E&)N%#2 also 'no8n as sentinel lymph node mapping2 is
a minimally inasie surgical approach that2 in some instances2 has replaced more inasie
lymph node dissections Elymphadenectomy# and their associated complications such as
lymphedema and delayed healing. &)N% has been 8idely adopted for regional lymph node
staging in selected cases of melanoma and breast cancer. Options % and C are incorrect.
07. <ou are caring for a patient 8ho has -ust been told that her stage *C colon cancer has
recurred and metastasiDed to the lier. The oncologist offers the patient the option of surgery to
treat the progression of this disease. What type of surgery does the oncologist offer"
!# +alliatie
%# Aeconstructie
C# &alage
(# +rophylactic
!ns: !
Chapter: 16
Client Needs: (-.
Ob-ectie: 6
4eedbac': When cure is not possible2 the goals of treatment are to ma'e the patient as
comfortable as possible and to promote ;uality of life as defined by the patient and his or her
family. +alliatie surgery is performed in an attempt to reliee complications of cancer2 such as
ulceration2 obstruction2 hemorrhage2 pain2 and malignant effusion. Aeconstructie surgery may
follo8 curatie or radical surgery in an attempt to improe function or obtain a more desirable
cosmetic effect. &alage surgery is an additional treatment option that uses an e$tensie surgical
approach to treat the local recurrence of a cancer after the use of a less e$tensie primary
approach. +rophylactic surgery inoles remoing nonital tissues or organs that are at increased
ris' to deelop cancer.
01. <ou are caring for a patient 8ith an adanced stage of breast cancer. The cancer has
metastasiDed. <ou enter the room and find the patient struggling to breath. <ou note that this
patient=s -ugular eins are distended. What 8ould you suspect is happening 8ith this patient"
!# *ncreased intracranial pressure
%# &uperior ena caa syndrome E&CC&#
C# &pinal cord compression
(# Metastatic tumor of the nec'
!ns: %
Chapter: 16
Client Needs: (-.
Ob-ectie: >
4eedbac': &uperior ena caa syndrome E&CC&# occurs 8hen there is gradual or sudden
impaired enous drainage giing rise to progressie shortness of breath Edyspnea#2 cough2
hoarseness2 chest pain2 and facial s8elling? edema of the nec'2 arms2 hands2 and thora$ and
reported sensation of s'in tightness and difficulty s8allo8ing? as 8ell as possibly engorged and
distended -ugular2 temporal2 and arm eins. Option ! is incorrect? increased intracranial pressure
may be a part of &CC&2 but it is not 8hat is causing the patient=s symptoms. Option C is
incorrect? the scenario does not mention a problem 8ith the patient=s spinal cord. Option ( is
incorrect? the scenario says that the cancer has metastasiDed but not that it has metastasiDed to the
nec'.
09. <ou are a hospice nurse caring for a patient 8ith cancer in her home. <ou hae e$plained to
the patient and the family that the patient is at ris' for hypercalcemia. <ou hae educated them
on that signs and symptoms of hypercalcemia. What else 8ould you teach this patient and family
to do to reduce the ris' of hypercalcemia"
!# &tool softeners are contraindicated.
%# )a$aties should be ta'en daily.
C# Consume 9 to . ) of fluid daily.
(# Aestrict calcium inta'e.
!ns: C
Chapter: 16
Client Needs: (-.
Ob-ectie: >
+age and /eader: 0::2 Nursing Care of +atients 8ith Cancer
4eedbac': *dentify patients at ris' for hypercalcemia and assess for signs and symptoms of
hypercalcemia. 3ducate the patient and family? preention and early detection can preent
fatality. Teach at-ris' patients to recogniDe and report signs and symptoms of hypercalcemia.
3ncourage patients to consume 9 to . ) of fluid daily unless contraindicated by e$isting renal or
cardiac disease. 3$plain the use of dietary and pharmacologic interentions such as stool
softeners and la$aties for constipation. !dise patients to maintain nutritional inta'e 8ithout
restricting normal calcium inta'e.
Multiple &election
00. <ou are caring for an oncology patient at ris' for disseminated intraascular coagulation
E(*C#. What 8ould be the appropriate care for this patient" EMar' all that apply.#
!# !ssist patient to turn2 cough2 and deep breathe
%# !ccurate * K O
C# +reent bleeding
(# !ssess hearing disturbances
3# Ma$imiDe physical actiity
!ns: !2 %2 C
Chapter: 16
Client Needs: (-0
Ob-ectie: 11
+age and /eader: 0:>2 Nursing Care of +atients 8ith Cancer
4eedbac': Nursing care of the patient in (*C: Monitor ital signs. Measure and document inta'e
and output. !ssess s'in color and temperature? lung2 heart2 and bo8el sounds? leel of
consciousness? headache? isual disturbances? chest pain? decreased urine output? and abdominal
tenderness. *nspect all body orifices2 tube-insertion sites2 incisions2 and bodily e$cretions for
bleeding. Aeie8 laboratory test results. MinimiDe physical actiity to decrease in-ury ris's and
o$ygen re;uirements. +reent bleeding? apply pressure to all enipuncture sites2 and aoid
nonessential inasie procedures? proide electric rather than straight-edged raDors? aoid tape
on the s'in and adise gentle but ade;uate oral hygiene. !ssist the patient to turn2 cough2 and
ta'e deep breaths on a regular schedule. Aeorient the patient2 if needed? maintain a safe
enironment? and proide appropriate patient education and supportie measures. Option ( is
incorrect? hearing disturbances 8ould be important to assess for.
Multiple Choice
0.. <ou are a home health nurse caring for an oncology patient discharged home 0 days ago
after completing therapy. What 8ould you assess the patient for"
!# Tumor lysis syndrome
%# &yndrome of inappropriate antiduretic hormone
C# (isseminated intraascular coagulation
(# /ypercalcemia
!ns: !
Chapter: 16
Client Needs: (-0
Ob-ectie: 11
+age and /eader: 0>72 Nursing Care of +atients 8ith Cancer
4eedbac': Nursing care for tumor lysis syndrome: identify at-ris' patients2 including those in
8hom tumor lysis syndrome may deelop up to 1 8ee' after therapy has been completed.
*nstitute essential preentie measures Eeg2 fluid hydration and allopurinol#. !ssess patients for
signs and symptoms of electrolyte imbalances. !ssess urine p/ to confirm al'aliDation. Monitor
serum electrolyte and uric acid leels for eidence of fluid olume oerload secondary to
aggressie hydration. *nstruct patients to report symptoms indicating electrolyte disturbances.
Options %2 C2 and ( are incorrect.
06. <ou are admitting an oncology patient to your unit prior to surgery. The patient has -ust
finished radiation therapy. What does this put your patient at increased ris' for"
!# Nutritional deficit
%# *mpaired 8ound healing
C# Cardiac tamponade
(# Tumor lysis syndrome
!ns: %
Chapter: 16
Client Needs: (-.
Ob-ectie: >
4eedbac': Combining other treatment methods2 such as radiation and chemotherapy2 8ith
surgery also contributes to postoperatie complications2 such as infection2 impaired 8ound
healing2 altered pulmonary or renal function2 and the deelopment of deep ein thrombosis.
06. <our patient has -ust returned from the +!C5 after salage surgery for renal carcinoma.
What 8ould you assess this patient for"
!# Casoconstriction
%# !nore$ia
C# Wound dehiscence
(# Metastasis to the brain
!ns: C
Chapter: 16
Client Needs: (-0
Ob-ectie: >
+age and /eader: 0.>2 Management of Cancer
4eedbac': +ostoperatiely2 the nurse assesses the patient=s responses to the surgery and monitors
the patient for possible complications2 such as infection2 bleeding2 thrombophlebitis2 8ound
dehiscence2 fluid and electrolyte imbalance2 and organ dysfunction. Options !2 %2 and ( are
incorrect. Casoconstriction2 anore$ia2 and metastasis to the brain are all things you 8ould assess
for een if your patient had not -ust returned from salage surgery.
01. <ou hae -ust admitted a ne8 patient to the hospice program you 8or' for. While you are
doing the initial assessment2 a family member states2 @my sister -ust 8on=t tal' to any of us about
8hat is happening to her.B What should you do"
!# &trie to facilitate communication bet8een the family and health care proiders.
%# &trie to facilitate communication bet8een the patient and health care proiders.
C# &trie to facilitate communication bet8een family members and yourself.
(# &trie to facilitate communication among family members.
!ns: (
Chapter: 16
Client Needs: (-.
*ntegrated +rocess: Communication and (ocumentation
Ob-ectie: 17
+age and /eader: 0>12 Nursing Care of +atients 8ith Cancer
4eedbac': /ospice programs strie to facilitate clear communication among family members
and health care proiders.
0:. What is the most important focus of hospice care"
!# 4ocus of care is on the family as 8ell as the patient.
%# 4ocus of care is on the patient centrally and the family peripherally.
C# 4ocus of care is solely on the patient.
(# 4ocus of care emotionally is totally on the family.
!ns: !
Chapter: 16
Client Needs: (-.
(ifficulty: 3asy
Ob-ectie: 17
4eedbac': The focus of hospice care is on the family as 8ell as the patient. Therefore options %2
C2 and ( are incorrect.
0>. <ou are caring for a 1.-year-old female patient 8ith leu'emia. &he has deeloped alopecia
due to treatment for the leu'emia. What 8ould be an e$pected outcome found on her plan of
care"
!# Maintains ade;uate hydration
%# *nteracts and socialiDes 8ith others
C# CerbaliDes positie self-a8areness
(# Maintains academic standing in school
!ns: %
Chapter: 16
Client Needs: (-.
Ob-ectie: :
4eedbac': 3$pected outcomes of the nursing diagnosis @impaired tissue integrity: alopeciaB
identifies alopecia as potential side effect of treatment. Maintains hygiene and grooming.
*nteracts and socialiDes 8ith others. Option ! is incorrect? the scenario does not indicate the
patient is at ris' for inade;uate hydration. Option C is incorrect? you 8ould 8ant the patient to
erbaliDe a positie self-image2 not self-a8areness. (uring treatment for leu'emia2 it 8ould be
nice to maintain academic standing2 but it 8ould not be on the care plan at this time.
.7. <ou are the clinic nurse caring for a patient 8ho 8as -ust told he 8as cancer free at 6 years
after diagnosis. The patient has been told he is a cancer surior. What is cancer suriorship"
!# The period -ust after being pronounced cancer-free 6 years after being diagnosed
%# The time during 8hich the patient lies 8ith an actie diagnosis of cancer
C# ! phase of cancer care that comes after primary treatment and lasts until cancer recurrence or
the end of life
(# The end of cancer care
!ns: C
Chapter: 16
Client Needs: %
(ifficulty: 3asy
Ob-ectie: :
+age and /eader: 0>12 Cancer &uriorship
4eedbac': Cancer suriorship refers to a distinct phase of cancer care that follo8s primary
treatment for cancer and lasts until cancer recurrence or end of life.

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Chapter: Chapter 16: Oncology: Nursing Management in Cancer Care

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