Question 1

During the teaching session for a patient who has a new diagnosis of acute leukemia the patient is restless and is looking away,never making eye contact.After teaching about the complications associated with chemotherapy,the patient asks the nurse to repeat all of the information.Based on this assessment,which nursing diagnosis is most appropriate for the patient?

Accepted Answer

The patient who has a new cancer diagnosis is likely to have high anxiety,which may impact learning and require that the nurse repeat and reinforce information.The patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion.The patient asks for the information to be repeated,indicating that lack of interest in learning and denial are not etiologic factors.

Question 2

The nurse teaches a patient with cancer of the liver about high-protein,high-calorie diet choices.Which snack choice by the patient indicates that the teaching has been effective?

Accepted Answer

Yogurt has high biologic value because of the protein and fat content.Fruit salad does not have high amounts of protein or fat.Lime sherbet is lower in fat and protein than yogurt.Cream cheese is low in protein.

Question 3

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT).The nurse will include which information in the patient's teaching plan?

Accepted Answer

The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells.The transplanted cells are infused through an IV line,so the transplant is not painful,nor is an operating room or incision required.

Question 4

Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration?

Accepted Answer

Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop "chemo-brain" while receiving chemotherapy.Patients should be encouraged to exercise the brain through new activities.Chemo-brain may be short- or long-term.There is no urgent need to report common chemotherapy side effects to the provider.

Question 5

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in conjunction with the prescribed chemotherapy.Which finding by the nurse is most important to report to the health care provider?

Accepted Answer

Rapid fluid infusions may cause heart failure,especially in older patients.The other findings are common in patients who have cancer and/or are receiving chemotherapy.

Question 6

The nurse reviews the laboratory results of a patient who is receiving chemotherapy.Which laboratory result is most important to report to the health care provider?

Accepted Answer

The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen)are needed.Although the other laboratory data indicate decreased levels,they do not indicate any immediate life-threatening adverse effects of the chemotherapy.

Question 7

The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan).Which assessment finding would require the most rapid action by the nurse?

Accepted Answer

Rituximab (Rituxan)is a monoclonal antibody.Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration.The nurse will need to rapidly take actions such as stopping the infusion,assessing the patient further,and notifying the health care provider.The other findings will also require action by the nurse,but are not indicative of life-threatening complications.

Question 8

The nurse receives change-of-shift report on the oncology unit.Which patient should the nurse assess first?

Accepted Answer

Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck,this patient should be seen first.The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

Question 9

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer.Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider?

Accepted Answer

An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified.The other patient findings are common adverse effects of chemotherapy.The nurse may need to address these,but they would not necessarily indicate a need for a change in therapy.

Question 10

Interleukin-2 (IL-2)is used as adjuvant therapy for a patient with metastatic renal cell carcinoma.Which information should the nurse include when explaining the purpose of this therapy to the patient?

Accepted Answer

IL-2 enhances the ability of the patient's own immune response to suppress tumor cells.IL-2 does not protect normal cells from damage caused by chemotherapy,stimulate malignant cells to enter mitosis,or prevent bone marrow depression.

Question 11

The nurse is caring for a patient who has been diagnosed with stage I cancer of the colon.When assessing the need for psychologic support,which question by the nurse will provide the most information?

Accepted Answer

Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness.The length of time since the diagnosis will not provide much information about the patient's need for support.The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance.Because surgical interventions for stage I cancer of the colon may not cause any body image changes,this question is not appropriate at this time.

Question 12

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia.Which observation by the nurse would indicate a need for further teaching?

Accepted Answer

Fresh,thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present.The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors.Because overuse of soap can dry the skin and increase infection risk,showering every other day is acceptable.Careful cleaning after having a bowel movement will help prevent skin breakdown and infection.

Question 13

The nurse assesses a patient who is receiving interleukin-2.Which finding should the nurse report immediately to the health care provider?

Accepted Answer

Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2.The patient may need oxygen and the nurse should rapidly notify the health care provider.The other findings are common side effects of interleukin-2.

Question 14

When caring for a patient who is pancytopenic,which action by unlicensed assistive personnel (UAP)indicates a need for the nurse to intervene?

Accepted Answer

Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding.The other actions are appropriate for oral care of a pancytopenic patient.

Question 15

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation.Which nursing action is most appropriate?

Accepted Answer

The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead.Additional spice is not usually an effective way to enhance taste.Adding baby meats to foods will increase calorie and protein levels,but does not address the issue of taste.The patient's poor intake is not caused by a lack of information about nutrition.

Question 16

A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members.Which finding by the nurse indicates that teaching regarding pain management has been effective?

Accepted Answer

For chronic cancer pain,analgesics should be taken on a scheduled basis,with additional doses as needed for breakthrough pain.Taking the medications only when pain reaches a certain level does not provide effective pain control.Although nonopioid analgesics also may be used,there is no maximum dose of opioid.Opioids are given until pain control is achieved.The IV route is not more effective than the oral route,and usually the oral route is preferred.

Question 17

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain.Which action should the nurse take first?

Accepted Answer

Spinal cord compression,an oncologic emergency,can occur with invasion of tumor into the epidural space.The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider.Administration of opioids or use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression.

Question 18

The nurse supervises the care of a patient with a temporary radioactive cervical implant.Which action by unlicensed assistive personnel (UAP),if observed by the nurse,would require an intervention?

Accepted Answer

Because patients with temporary implants emit radioactivity while the implants are in place,exposure to the patient is limited.Laundry and urine/feces do not have any radioactivity and do not require special precautions.Cervical radiation will not affect the oral mucosa,and alcohol-based mouthwash is not contraindicated.

Question 19

The home health nurse cares for a patient who has been receiving interferon therapy for treatment of cancer.Which statement by the patient indicates a need for further assessment?

Accepted Answer

Fatigue can be a dose-limiting toxicity for use of biologic therapies.Flulike symptoms,such as muscle aches and chills,are common side effects with interferon use.Patients are advised to use acetaminophen every 4 hours.

Question 20

The nurse is caring for a patient with left-sided lung cancer.Which finding would be most important for the nurse to report to the health care provider?

Accepted Answer

Syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia)is an oncologic metabolic emergency and will require rapid treatment in order to prevent complications such as seizures and coma.The other findings also require intervention,but are common in patients with lung cancer and not immediately life threatening.

Quiz 12: Cancer