Nokea
A patient who has severe pain associated with terminal liver cancer is being cared for at home by family members. Which of the following findings indicates that teaching regarding pain management has been effective?
- A. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness.
- B. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0-10 scale).
- C. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
- D. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.
Correct Answer: C
Rationale: For persistent 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 also may 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.
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When assessing the need for psychological support after the patient has been diagnosed with stage I cancer of the colon, which of the following questions by the nurse will provide the most information?
- A. How long ago were you diagnosed with this cancer?
- B. Do you have any concerns about body image changes?
- C. Can you tell me what has been helpful to you in the past when coping with stressful events?
- D. Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?
Correct Answer: C
Rationale: Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Since surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time.
Which of the following nursing actions will be most effective in improving oral intake for a patient with the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers?
- A. Offer the patient frequent small snacks between meals.
- B. Assist the patient to choose favourite foods from the menu.
- C. Provide education about the importance of nutritional intake.
- D. Apply the ordered anaesthetic gel to oral lesions before meals.
Correct Answer: D
Rationale: Since the etiology of the patient's poor nutrition is the painful oral ulcers, the best intervention is to apply anaesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition, but would not be as helpful for this patient.
The nurse is preparing a patient for a biopsy of a lump in the right breast and the patient asks the nurse about the difference between a benign tumour and a malignant tumour. Which of the following responses by the nurse is correct?
- A. Benign tumours do not cause damage to other tissues.
- B. Benign tumours are likely to recur in the same location.
- C. Malignant tumours may spread to other tissues or organs.
- D. Malignant cells reproduce more rapidly than normal cells.
Correct Answer: C
Rationale: The major difference between benign and malignant tumours is that malignant tumours invade adjacent tissues and spread to distant tissues and benign tumours never metastasize. The other statements are inaccurate. Both types of tumours may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumours do not usually recur.
The nurse is teaching a patient who is postmenopausal and has stage III breast cancer about the expected outcomes of her 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 tumour is surgically removed.
- C. Cancer is never considered cured, but the tumour can be controlled with surgery, chemotherapy, and radiation.
- D. I will need to have follow-up examinations for many years after I have treatment before I can be considered cured.
Correct Answer: D
Rationale: The risk of recurrence varies by the type of cancer. For breast cancer in postmenopausal women the patient needs at least 20 disease-free years to be considered cured. Some cancers are considered cured after a shorter time span, or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.
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?
- A. I have frequent muscle aches and pains.
- B. I rarely have the energy to get out of bed.
- C. I experience chills after I inject the interferon.
- D. I take acetaminophen every 4 hours.
Correct Answer: B
Rationale: Fatigue can be a dose-limiting toxicity of biological therapies. Flulike symptoms, such as muscle aches and chills, are common adverse effects of interferon use. Patients are advised to use acetaminophen every 4 hours.