NUR 2790 PROFESSIONAL NURSING
CH 16 CANCER MANAGEMENT
FINAL EXAM
1. After 3 weeks of radiation therapy, H.J. has lost 10 pounds and does not eat
well
... [Show More] because of mucositis. An appropriate nursing diagnosis for the patient is:
A. Risk for infection related to poor nutrition
B. Ineffective self-health management related to refusal to eat
C. Imbalanced nutrition: less than body requirements related to oral inflammation
and ulceration
D. Ineffective health maintenance related to lack of knowledge of nutritional
requirements during radiation therapy
Rationale:
Oral Mucositis is irritation, inflammation, and/or ulceration of the oral mucosa that
is common in patients receiving radiation to the head and neck.
2. To prevent the debilitating cycle of fatigue-depression-fatigue that can occur in
patients with cancer, an appropriate nursing intervention is to:
A. Have the patient rest after any major energy expenditure
B. Encourage the patient to implement a daily walking program
C. Teach the patient to ignore the fatigue to maintain normal daily activities
D. Prevent the development of depression by informing the patient to expect
fatigue during cancer treatment
Rationale:
Maintaining exercise and activity within tolerable limits is often helpful in
managing fatigue. Walking programs are a way for most patients to keep active
without overtaxing them. Patients should plan energy conservation strategies by
identifying days/times when they feel better and can tolerate activity. Resting
before activity and having others assist with work or home management may be
necessary. Ignoring fatigue and overstressing the body can lead to an increase in
symptoms
3. A patient who is scheduled for a right breast biopsy asks the nurse the
difference between a benign tumor and a malignant
tumor. Which answer by the nurse is correct?
A. "Benign tumors do not cause damage to other tissues."
B. "Benign tumors are likely to recur in the same location."
C. "Malignant tumors may spread to other tissues or organs."
D. "Malignant cells reproduce more rapidly than normal cells."
Rationale: The major difference between benign and malignant tumors is that
malignant tumors invade adjacent tissues and spread to distant tissues and
benign tumors never metastasize. The other statements are inaccurate. Both
types of tumors may cause damage to adjacent tissues. Malignant cells do not
reproduce more rapidly than normal cells. Benign tumors do not usually recur.
4. The nurse is caring for a patient receiving intravesical bladder chemotherapy.
The nurse should monitor for which adverse effect?
A. Nausea
B. Alopecia
C. Mucositis
D. Hematuria
Rationale:
The adverse effects of intravesical chemotherapy are confined to the bladder.
The other adverse effects are associated with systemic chemotherapy
5. The nurse teaches a patient who is scheduled for a prostate needle biopsy
about the procedure. Which statement, if made by the patient, indicates that
teaching was effective?
A. "The biopsy will remove the cancer in my prostate gland."
B "The biopsy will determine how much longer I have to live."
C. "The biopsy will help decide the treatment for my enlarged prostate."
D. "The biopsy will indicate whether the cancer has spread to other organs."
Rationale:
A biopsy is used to determine whether the prostate enlargement is benign or
malignant, and determines the type of treatment that will be needed. A biopsy
does not give information about metastasis, life expectancy, or the impact of
cancer on the patient's life.
6. The nurse administers an IV vesicant chemotherapeutic agent to a patient.
Which action is most important for the nurse to take?
A. Infuse the medication over a short period of time.
B. Stop the infusion if swelling is observed at the site.
C. Administer the chemotherapy through a small-bore catheter.
D. Hold the medication unless a central venous line is available.
Rationale: Swelling at the site may indicate extravasation, and the IV should be
stopped immediately. The medication generally should be given slowly to avoid
irritation of the vein. The size of the catheter is not as important as administration
of vesicants into a running IV line to allow dilution of the chemotherapeutic drug.
These medications can be given through peripheral lines, although central
vascular access devices (CVADs) are preferred.
7. 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?
A. Transplant of the donated cells is painful because of the nerves in the tissue
lining the bone.
B. Donor bone marrow cells are transplant through an incision into the sternum
or hip bone.
C. The transplant procedure takes place in a sterile operating room to minimize
the risk for infection.
D. Hospitalization will be required for several weeks after the stem transplant
procedure is performed.
Rationale: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.
8. A hospitalized patient who has received chemotherapy for leukemia develops
neutropenia. Which observation by the nurse would indicate a need for further
teaching?
A. The patient ambulates several times a day in the room
B. The patient's visitors bring in some fresh peaches/ plants from home.
C. The patient cleans with a warm washcloth after having a stool
D. The patient uses soap and shampoo to shower every other day.
Rationale:
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.
9. The nurse assesses a patient who is receiving interleukin-2. Which finding
should the nurse report immediately to the health care provider?
A. Generalized muscle aches
- can indicate liver problems
B. Complaints of nausea and anorexia
C. Oral temperature of 100.6 degrees F (38.1 degrees C)
D. Crackles heard at the lower scapular border
Rationale:
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.
10. After change-of-shift report on the oncology unit, which patient should the
nurse assess first?
A. Patient who has a platelet count of 82,000/µL after chemotherapy
B. Patient who has xerostomia after receiving head and neck radiation
C. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C)
D. Patient who is worried about getting the prescribed long-acting opioid on time
Rationale:
Temperature elevation is an emergency in neutropenic patients because of the
risk for rapid progression to severe infections and sepsis. The other patients also
require assessments or interventions, but do not need to be assessed as
urgently. Patients with thrombocytopenia do not have spontaneous bleeding until
the platelets are 20,000/µL. Xerostomia does not require immediate intervention.
Although breakthrough pain needs to be addressed rapidly, the patient does not
appear to have breakthrough pain.
11. 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?
A. Shortness of breath
B. Temperature of 100.2 degrees F (37.9 degrees C)
C. Shivering and complaint of chills
D. Generalized muscle aches and pains
Rationale:
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.
12. A patient with a large stomach tumor that is attached to the liver is scheduled
to have a debulking procedure. Which information should the nurse teach the
patient about the outcome of this procedure?
A. Pain will be relieved by cutting sensory nerves in the stomach.
B. Relief of pressure in the stomach will promote better nutrition.
C. Tumor growth will be controlled by the removal of malignant tissue.
D. Tumor size will decrease and this will improve the effects of other therapy.
Rationale:
A debulking surgery reduces the size of the tumor and makes radiation and
chemotherapy more effective. Debulking surgeries do not control tumor growth.
The tumor is debulked because it is attached to the liver, a vital organ (not to
relieve pressure on the stomach). Debulking does not sever the sensory nerves,
although pain may be lessened by the reduction in pressure on the abdominal
organs. [Show Less]