ATI Medical-Surgical: Oncology

A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing bladder cancer?

The client is a hairdresser.

The client uses tobacco.

The client is over 60 years of age.

The client has frequent urinary tract infections (UTIs)

The client uses tobacco.

The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow’s hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should identify the client’s tobacco use as being the greatest risk factor for developing bladder cancer.

A nurse is providing discharge teaching to a client who is postoperative following a right mastectomy for breast cancer. The client will be discharged with two Jackson-Pratt drainage tubes. Which of the following information should the nurse include in the teaching?

“Empty the drainage tubes once per day.”

“Showering is permitted before the drainage tubes are removed.”

“The drainage tubes often are removed at the same time as the stitches.”

“Do not begin exercising the arm until the provider removes the drainage tubes.”

“The drainage tubes often are removed at the same time as the stitches.”

The nurse should instruct the client that the provider will remove the drainage tubes at the same time the stitches are removed, usually within 7 to 10 days.

A nurse is admitting a client who has multiple myeloma and a WBC count of 2,200/mm3. Which of the following foods should the nurse prohibit the family members from bringing to the client?

Fried chicken from a fast food restaurant

A case of canned nutritional supplements

A factory-sealed box of chocolates

A fresh fruit basket

A fresh fruit basket

Raw fruits and vegetables are contraindicated for a client who has neutropenia, as the skin might harbor bacteria that can cause an infection. The nurse should prohibit these foods from entering the client’s room.

A nurse is providing preoperative teaching for a client who has colorectal cancer and is to undergo placement of a colostomy with a perineal wound. Which of the following statements by the client indicates an understanding of the teaching?

“It will be a relief to not have any further rectal pain.”

“I will need to sit on a rubber donut when I am out of bed in the chair.”

“I can have only liquids for 2 days before the surgery.”

“The colostomy will start working about 7 days after the surgery.”

“I can have only liquids for 2 days before the surgery.”

The client should consume a full or clear liquid diet for 24 to 48 hr before the surgery to decrease bulk. The client should consume a low-residue diet for several days prior to surgery to decrease peristalsis.

A nurse is collecting a health history from a female client who is undergoing screening for breast cancer. Which of the following factors places the client at a high increased risk for developing breast cancer?

Obesity

Oral contraceptive use

Alcohol use

Over 50 years of age

Over 50 years of age

A female client whose age is over 50 years has a high increased risk for developing breast cancer.

A nurse on an oncology unit is providing discharge teaching to an adolescent female client who received a bone marrow transplant for leukemia. Which of the following information should the nurse include in the teaching? (Select all that apply.)

“Take your temperature twice each day.”

“You may return to school if you feel strong enough.”

“It is important to always wear shoes.”

“Clean your toothbrush weekly with isopropyl alcohol.”

“Avoid using tampons.”

Take your temperature twice each day

It is important to always wear shoe

Avoid using tampons

“Take your temperature twice each day” is correct. Clients who are postoperative bone marrow transplants are immunosuppressed and should continually monitor for manifestations of infection. A temperature that is greater than 38° C (100° F) should be reported immediately to the provider.

“It is important to always wear shoes” is correct. A client who had a bone marrow transplant is immunosuppressed and should wear shoes to prevent injury and decrease the risk for infection.

“Avoid using tampons” is correct. The use of tampons is discouraged because they can disrupt the mucosal layer of the vagina and, if left in too long, can support the growth of bacteria.

A nurse is caring for a client who has breast cancer and is receiving a combination of chemotherapy medications. The client expresses confusion about the therapy. Which of the following explanations should the nurse provide?

“The risk of renal toxicity is lessened when a combination of chemotherapy medications are used.”

“The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed.”

“The use of more chemotherapy medications will shorten the time you have to be in treatment.”

“The combination of chemotherapy medications will eliminate the potential for bone marrow suppression.”

“The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed.”

Different chemotherapeutic agents act at various stages of cellular mitosis (division). By combining agents, medication therapy is more effective in stopping or slowing the growth of cancerous cells by interfering with their ability to multiply.

A nurse is obtaining a health history from a client who has cancer of the cervix. Which of the following manifestations should the nurse expect?

Weight gain

Oliguria

Vaginal bleeding

Back pain

Vaginal bleeding

The most common manifestation of cancer of the cervix is painless vaginal bleeding.

A nurse is caring for a client who has testicular cancer and is experiencing peripheral neuropathy as an adverse effect of chemotherapy. Which of the following client manifestations is an expected finding of peripheral neuropathy?

Thinning of the scalp hair

Tingling of the hands and feet

Reduced ability to concentrate

Sores in the mucous membranes

Tingling of the hands and feet

Several chemotherapeutic agents might cause peripheral neuropathy. One of the major manifestations of peripheral neuropathy is numbness and tingling of an extremity.

A nurse is monitoring a client who has cancer and is receiving chemotherapy by peripheral IV infusion. The client reports pain at the insertion site and the nurse notes fluid leaking around the catheter. Which of the following actions should the nurse take first?

Take a photograph of the peripheral IV site.

Obtain and record the client’s vital signs.

Stop the infusion.

Identify all medications administered through the IV site for the past 24 hr.

Stop the infusion.

The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow’s hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. Many chemotherapy medications are vesicants that can cause extensive tissue damage if extravasation occurs; therefore, the nurse’s first action should be to stop the infusion immediately.

A nurse is providing discharge teaching to a client following open radical prostatectomy. The client is going home with an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching?

“I will be able to take a tub bath in 1 week.”

“I will change the catheter drainage bag once each week.”

“I will use suppositories to prevent constipation.”

“I will regain my bladder control once the catheter is removed.”

“I will change the catheter drainage bag once each week.”

The nurse should teach the client how to change the catheter drainage bag and to change the bag at least once each week.

A nurse is providing teaching to a client who has cancer and is receiving external radiation therapy. Which of the following statements by the client indicates an understanding of the teaching?

“I need to protect the area from sunlight.”

“I’m going to apply a heating pad to the area after each treatment.”

“I’ll massage the area once per day.”

“I’ll wash the markings off after each therapy treatment.”

“I need to protect the area from sunlight.”

To prevent skin irritation and subsequent breakdown, the nurse should instruct the client to protect areas of skin from sunlight that receive radiation.

A nurse in an oncology clinic is assessing a client who has early stage Hodgkin’s lymphoma. Which of the following findings should the nurse expect?

Bone and joint pain

Enlarged lymph nodes

Intermittent hematuria

Productive cough

Enlarged lymph nodes

Hodgkin’s lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. The first manifestation of this cancer is often an enlarged painless lymph node, or nodes, which appear without a known cause. Other early manifestations include night sweats, unexplained weight loss, fever, and pruritus. The disease can spread to adjacent lymph nodes and later might spread outside the lymph nodes to the lungs, liver, bones, or bone marrow. The spread of Hodgkin’s lymphoma is usually in an ordered pattern.

A hospice nurse is providing education about palliative care to the partner of a client who has end-stage liver cancer. Which of the following statements by the partner indicates an understanding of teaching?

“I will do my best to try to get him to eat something.”

“I will lay him flat if his breathing becomes shallow.”

“I will use an electric blanket to keep him warm.”

“I will continue to talk to him even when he’s sleeping.”

“I will continue to talk to him even when he’s sleeping.”

The nurse should reinforce to the partner that the client’s hearing is thought to be the last sense to leave when in the dying process. Therefore, continue to softly communicate with the client.

A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing skin cancer?

Age over 60

Genetic predisposition

Light-skinned race

Overexposure to sun light

Overexposure to sun light

The nurse should apply the safety and risk reduction priority-setting framework when caring for this client. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow’s hierarchy of needs, the ABC priority setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should identify the client’s overexposure to sun as being the greatest risk factor for developing skin cancer.

A nurse is providing postoperative discharge teaching to a client following a panhysterectomy for uterine cancer. Which of the following information should the nurse include in the teaching?

“You will need to continue to use some form of birth control for 6 months.”

“You might experience manifestations of menopause.”

“Do not lift anything heavier than 15 pounds.”

“Pain or burning on urination is an expected outcome of this surgery.”

“You might experience manifestations of menopause.”

The nurse should inform the client that a panhysterectomy includes the removal of the uterus and the ovaries that might cause manifestations of menopause to occur. Manifestations of menopause include hot flashes, night sweats, and vaginal dryness.

A nurse is caring for a client who is postoperative following a urinary diversion to treat bladder cancer. Which of the following interventions should the nurse include in the plan of care?

Empty the collection pouch when it is 2/3 full.

Expect urine outflow into pouch to begin 1 to 2 days following surgery.

Change the collection pouch in the early morning.

Place an aspirin in the collection pouch to control odor.

Change the collection pouch in the early morning.

The nurse should plan to change the urinary collection pouch in the early morning when urine output is reduced.

A nurse is caring for a client who has lung cancer that has metastasized. Which of the following findings indicates the client is developing superior vena cava syndrome?

Irregular cardiac rhythm

Numbness in the hands

Muscle cramps

Facial edema

Facial edema

Superior vena cava syndrome is a medical emergency resulting from a partial occlusion of the superior vena cava, leading to a decreased blood flow through the vein. Most cases of superior vena cava syndrome are associated with cancers involving the client’s upper chest, such as advanced lung and breast cancers and lymphoma. The earliest manifestations of superior vena cava syndrome are facial and upper extremity edema. Death can result if the compression is not corrected.

A nurse is planning care for a client who has cancer and has developed thrombocytopenia following chemotherapy. Which of the following precautions should the nurse offer to minimize the adverse effects of thrombocytopenia?

Monitor visitors for manifestations of infection.

Remind the client to use an electric razor.

Encourage frequent rest periods.

Instruct the client to rinse mouth daily with normal saline.

Remind the client to use an electric razor.

Thrombocytopenia is a decrease in the client’s blood platelet count, which places the client at an increased risk of bleeding due to the blood’s inability to clot. Therefore, the nurse should institute bleeding precautions, which includes the use of an electric razor.

A nurse is caring for a client who is receiving chemotherapy to treat cancer. Which of the following adverse effects should the nurse anticipate from the chemotherapy?

Gingival hyperplasia

Hirsutism

Pancytopenia

Weight gain

Pancytopenia

Pancytopenia, a deficiency of WBCs, RBCs, and platelet counts, is an expected adverse effect of chemotherapy.