Nokea
A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate?
- A. Avoid getting salt water on the radiation site.
- B. Do not expose the radiation area to direct sunlight.
- C. Have a wonderful time and enjoy your vacation!
- D. Remember you should not drink alcohol for a year.
Correct Answer: B
Rationale: Post-radiation skin at the treatment site remains highly sensitive to ultraviolet (UV) rays due to damage to the epidermal layer, increasing the risk of burns, irritation, or delayed healing. The nurse's most appropriate response is to advise against exposing the radiation area to direct sunlight, a precaution that persists for at least a year after treatment to protect skin integrity. Avoiding saltwater isn't a standard concern unless the skin is broken, which isn't indicated here. Simply wishing the client well ignores the teaching opportunity and potential risk. The alcohol restriction isn't a universal post-radiation rule unless tied to specific treatments or conditions not mentioned. Educating about sun exposure empowers the client to enjoy the vacation safely, aligning with nursing's preventive care focus and ensuring the celebration isn't marred by avoidable complications.
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Mr Xavier, a 60-year-old accountant, was recently started on allopurinol 100 mg two months ago. This was increased to 200 mg three weeks ago in your clinic. He informed you that he was diagnosed with UTI and started on ciprofloxacin. Today, he returns to your clinic with maculopapular rashes on his trunk and abdomen. He has a low-grade fever of 37.5°C. Which is the most appropriate next step?
- A. Stop Ciprofloxacin and continue the chronic medications
- B. Prescribe paracetamol for pain relief and switch to Moxifloxacin 500 mg bd instead
- C. Continue medications and check for Dengue serology
- D. Stop Allopurinol
Correct Answer: D
Rationale: Rashes and fever post-allopurinol hike scream drug reaction stopping it nips hypersensitivity, like SJS risk, tied to uric acid meds over cipro's rarer skin hit. Quitting cipro alone misses the likely culprit; swapping antibiotics or dengue checks dodge the drug link; full stop's overkill. Clinicians halt allopurinol, watching this chronic fix's nasty turn, a swift call.
Appropriate statements regarding markers of outcome after major surgery in England in 2014 include:
- A. Data about each hospital's complication rates after surgery are readily available.
- B. Data about each hospital's 30-day mortality after surgery are readily available.
- C. For most procedures, 90-day mortality rate are similar to 30-day mortality rates.
- D. National Hospital Episode Statistics (HES) data are useful for monitoring the performance of units.
Correct Answer: B
Rationale: In 2014 England, surgical outcome transparency increased. Complication rates weren't universally published per hospital, varying by procedure and trust. However, 30-day mortality data were widely available, notably via NHS initiatives and specialty audits (e.g., National Joint Registry), reflecting short-term success. Ninety-day mortality often exceeds 30-day rates (e.g., in vascular surgery), capturing delayed deaths, so they're not typically similar. HES data, capturing inpatient episodes, help monitor trends and performance, though coding accuracy limits granularity. Weekend admission mortality was higher, per studies like 2015 BMJ, due to staffing and care differences. The availability of 30-day mortality data was a key quality metric, driving accountability and improvement in surgical care.
The nurse is preparing an adolescent diagnosed with leukemia for a lumbar puncture. The nurse determines that the child understands the reason for the procedure when the child states that the procedure is done to:
- A. Make sure I don't have meningitis along with my cancer.
- B. Relieve some of the pressure on my brain.
- C. Remove the blood cancer cells so I don't have to have surgery.
- D. Check to see if the cancer has spread through my spinal cord and brain.
Correct Answer: D
Rationale: A lumbar puncture (LP) in leukemia is performed to collect cerebrospinal fluid (CSF) to check for central nervous system (CNS) involvement cancer cells spreading to the spinal cord and brain a critical staging step that influences treatment, like intrathecal chemotherapy. The adolescent's statement about checking for spread reflects accurate understanding, essential for informed consent and reducing anxiety through clarity. Ruling out meningitis is a possible LP use, but in leukemia, CNS metastasis is the primary concern unless symptoms suggest infection. Relieving brain pressure applies to conditions like hydrocephalus, not leukemia's typical presentation. Removing cancer cells via LP isn't a treatment; it's diagnostic. The nurse's confirmation of this understanding ensures the child is prepared, aligning with pediatric oncology's emphasis on patient education and procedural readiness.
The nurse is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, what action should the nurse emphasize?
- A. Adjust the dose to the patient's present symptoms
- B. Wash hands with an alcohol-based cleanser following administration
- C. Use gloves and a lab coat when preparing the medication
- D. Dispose of the antineoplastic wastes in the hazardous waste receptacle
Correct Answer: D
Rationale: Antineoplastics are hazardous proper disposal in designated receptacles is critical to protect staff, patients, and the environment from toxic exposure. Gloves and gowns are standard for prep, but the question stresses one action, and disposal trumps as a universal safety net. Dosing's fixed by protocol, not symptoms tweaking's dangerous. Alcohol-based cleansers don't cut it post-exposure; soap and water are needed pre- and post-handling to remove residue. Emphasizing disposal aligns with OSHA and oncology nursing standards, ensuring chemo waste (e.g., IV bags, syringes) doesn't leak into regular trash, a key lesson for newbies in this high-stakes field.
The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?
- A. A 35-yr-old patient who has wet desquamation associated with abdominal radiation
- B. A 42-yr-old patient who is sobbing after receiving a new diagnosis of ovarian cancer
- C. A 24-yr-old patient who received neck radiation and has blood oozing from the neck
- D. A 56-yr-old patient who developed a new pericardial friction rub after chest radiation
Correct Answer: C
Rationale: Neck oozing post-radiation flags carotid rupture a bleed-out risk trumping wet skin , sobs , or heart rub (D tamponade's slower). Nurses in oncology bolt here airway and blood loss kill fastest, demanding stat checks.