Chronic Illness Questions

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A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best?

  • A. Call the client at home the next day to review teaching.
  • B. Give the client information about a cancer support group.
  • C. Provide all the preoperative instructions in writing.
  • D. Reassure the client that surgery will be over soon.
Correct Answer: A

Rationale: A new cancer diagnosis combined with the urgency of surgery in three days can overwhelm a client, impairing their ability to process and retain preoperative instructions due to emotional stress and anxiety. Calling the client the next day to review teaching allows the nurse to reinforce key points, answer questions, and ensure comprehension when the client may be calmer and more receptive. While providing written instructions is helpful, it assumes literacy and may not address immediate confusion or emotional barriers. Offering support group information is valuable for long-term coping but doesn't prioritize the urgent need for surgical preparation. Reassuring the client that surgery will be over soon dismisses their concerns and doesn't enhance understanding. The follow-up call is the best action, as it aligns with adult learning principles and nursing's role in ensuring informed consent and readiness, reducing perioperative risks and anxiety for the client.

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A 56-year-old patient comes to the walk-in clinic for scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history for colorectal cancer. While you are trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority diagnosis?

  • A. Diarrhea/Constipation related to altered bowel patterns
  • B. Knowledge Deficit related to disease process and diagnostic procedure
  • C. Risk for Fluid Volume Deficit related to rectal bleeding and diarrhea
  • D. Anxiety related to unknown outcomes and perceived threat to body integrity
Correct Answer: D

Rationale: The patient's anger and threat to leave during colonoscopy teaching signal emotional distress overriding physical symptoms. Anxiety stemming from uncertain outcomes and perceived bodily threat fits, as colorectal cancer risk tied to polyps and family history heightens fear, blocking education uptake. Diarrhea/constipation reflects symptoms but isn't immediately urgent with scant bleeding. Knowledge deficit exists but is secondary fear drives the refusal, not just ignorance. Fluid volume risk is plausible with bleeding, yet no data suggests acute loss; stability allows focus on emotions. Addressing anxiety first calms the patient, enabling teaching and care, a priority in this tense encounter where psychological barriers could delay critical colorectal screening and intervention.

The nurse is caring for a client with mitral regurgitation. Which of the following would the nurse anticipate the client to develop if left untreated?

  • A. Left-sided heart failure
  • B. Right-sided heart failure
  • C. Renal failure
  • D. Myocardial ischemia
Correct Answer: A

Rationale: Mitral regurgitation backflows blood into the left atrium, hiking pressure and volume untreated, it overburdens the left ventricle, leading to left-sided heart failure. Pulmonary congestion follows, with dyspnea and edema, a direct consequence of this valve flaw. Right-sided failure stems from downstream effects or separate causes, not primary here. Renal failure or ischemia might complicate advanced disease, but left-sided failure's progression is the immediate risk, rooted in mitral dysfunction's mechanics. Nurses anticipate this, monitoring for early signs like crackles, ensuring timely intervention to halt this predictable cardiac cascade.

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective?

  • A. After cancer has not recurred for 5 years, it is considered cured.
  • B. The cancer will be cured if the entire tumor is surgically removed.
  • C. I will need follow-up examinations for many years after treatment before I can be considered cured.
  • D. Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation.
Correct Answer: C

Rationale: Stage III breast cancer's advanced local spread means long-term vigilance, not a quick cured' label. Five years recurrence-free is a milestone, but not universal some hit sooner, others never. Surgery alone won't cut it; chemo and radiation tag-team it. Never cured' overstates control's the goal, but cure's possible. Nurses in oncology drill this: years of follow-ups track sneaky recurrence, key for stage III's tricky prognosis.

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
Correct Answer: C

Rationale: Neutropenia plus fever 100.5°F screams infection risk, a sepsis threat needing instant assessment per ABCs in this chemo-ravaged unit. Platelets at 82,000 bleed less urgently; xerostomia's dry mouth annoys, not kills; opioid timing's comfort, not crisis. Nurses hit fever first, anticipating cultures or antibiotics, a life-saving triage in oncology's fragile lineup.

While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action?

  • A. Stopping the administration of the drug immediately
  • B. Notifying the patient's physician
  • C. Continuing the infusion but decreasing the rate
  • D. Applying a warm compress to the infusion site
Correct Answer: A

Rationale: Doxorubicin's a vesicant swelling and pain scream extravasation, where it leaks into tissue, risking severe necrosis. Stopping the IV stat is priority to limit damage; delaying could worsen injury. Notifying the physician follows, but action comes first. Slowing the infusion keeps pumping toxin into the site disastrous. Warm compresses might spread the drug, unlike ice, which can help post-stoppage per protocol. Nurses must act fast, knowing vesicants like doxorubicin (an anthracycline) demand immediate cessation and often antidotes (e.g., dexrazoxane), critical in oncology to prevent permanent harm from chemo mishaps.

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