Cancer And Oncology | NCLEX Quiz 153 - Quiz, Flashcards & Trivia

1. A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse about all of these symptoms. Which one is most important to report to the health care provider?

Generalized aches

Dyspnea

Decreased appetite

Insomnia

Dyspnea may indicate capillary leak syndrome and pulmonary edema. which requires rapid treatment. The other symptoms are common with IL-2 therapy. and the nurse should teach the patient that these are common adverse effects that will resolve at the end of the therapy.

Explanation

Dyspnea may indicate capillary leak syndrome and pulmonary edema. which requires rapid treatment. The other symptoms are common with IL-2 therapy. and the nurse should teach the patient that these are common adverse effects that will resolve at the end of the therapy.

2. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying. and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is

“Why don’t we talk about the options you have for the care of your children?”

“Many patients with cancer live for a long time. so there is time to plan for your children.”

“For now you need to concentrate on getting well. not worry about your children.”

“Perhaps your ex-husband will take the children when you can’t care for them.”

This response expresses the nurse’s willingness to listen and recognizes the patient’s concern. The responses beginning “Many patients with cancer live for a long time” and “For now you need to concentrate on getting well” close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition. the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient’s ex-husband will take the children. more assessment information is needed before making plans.

Explanation

This response expresses the nurse’s willingness to listen and recognizes the patient’s concern. The responses beginning “Many patients with cancer live for a long time” and “For now you need to concentrate on getting well” close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition. the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient’s ex-husband will take the children. more assessment information is needed before making plans.

3. A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse. "I have intense pain most of the time now." The nurse recognizes that teaching regarding pain management has been effective when the patient

Uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-point scale.

States that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.

Agrees to take the medications by the IV route to improve effectiveness.

Takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.

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 may also 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 the oral route is preferred.

Explanation

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 may also 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 the oral route is preferred.

4. 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?

Fresh fruit salad

Orange sherbet

Strawberry yogurt

French fries

Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in calories from fat but low in protein.

Explanation

Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in calories from fat but low in protein.

5. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider?

Hemoglobin of 10 g/L

WBC count of 1700/µl

Platelets of 65.000/µl

Serum creatinine level of 1.2 mg/dl

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

Explanation

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

6. A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is

“Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer.”

“It is possible you may have some changes in your sexual function. and you may want to consider pretreatment harvesting of sperm if you want children.”

“The radiation will make you sterile. but your ability to have sexual intercourse will not be changed by the treatment.”

“You may have some temporary impotence during the course of the radiation. but normal sexual function will return.”

The impact on sperm count and erectile function depends on the patient’s pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.

Explanation

The impact on sperm count and erectile function depends on the patient’s pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.

7. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to

Provide foods that are highly spiced to stimulate the taste buds.

Avoid presenting foods for which the patient has a strong dislike.

Add strained baby meats to foods such as soups and casseroles.

Teach the patient to eat whatever is nutritious since food is tasteless.

The patient will eat more if disliked foods are avoided and foods that 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. Patients will not improve intake by eating foods that are beneficial but have unpleasant taste.

Explanation

The patient will eat more if disliked foods are avoided and foods that 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. Patients will not improve intake by eating foods that are beneficial but have unpleasant taste.

8. A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient. the nurse explains that

Hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT).

The transplant of the donated cells is painful because of the nerves in the tissue lining the bone.

Donor bone marrow cells are transplanted immediately after an infusion of chemotherapy.

The transplant procedure takes place in a sterile operating room to minimize the risk for infection.

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 required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs.

Explanation

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 required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs.

9. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to

Protect normal kidney cells from the damaging effects of chemotherapy.

Enhance the patient’s immunologic response to tumor cells.

Stimulate malignant cells in the resting phase to enter mitosis.

Prevent the bone marrow depression caused by chemotherapy.

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.

Explanation

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.

10. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment?

“I have frequent muscle aches and pains.”

“I rarely have the energy to get out of bed.”

“I take acetaminophen (Tylenol) every 4 hours.”

“I experience chills after I inject the interferon.”

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 Tylenol every 4 hours.

Explanation

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 Tylenol every 4 hours.