Nokea
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.
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A patient with a large stomach tumour that is attached to the liver is scheduled to have a debulking procedure. When teaching the patient, which of the following is the expected outcome of this surgery?
- A. Relief of pain by cutting sensory nerves in the stomach
- B. Control of the tumour growth by removal of malignant tissue
- C. Decrease in tumour size to improve the effects of other therapy
- D. Promotion of better nutrition by relieving the pressure in the stomach
Correct Answer: C
Rationale: A debulking surgery reduces the size of the tumour and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumour growth. The tumour is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.
The nurse is caring for a patient who is receiving a vesicant chemotherapeutic agent intravenously. Which of the following actions is most important?
- A. Infuse the medication over a short period of time.
- B. Stop the infusion if swelling is observed at the site.
- C. Administer the chemotherapy through small-bore catheter.
- D. Hold the medication unless a central venous line is available.
Correct Answer: B
Rationale: Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapeutic drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.
Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the nurse's teaching about the purpose of the biopsy has been effective?
- A. The biopsy will remove the cancer in my prostate gland.
- B. The biopsy will determine how much longer I have to live.
- C. The biopsy will help decide the treatment for my enlarged prostate.
- D. The biopsy will indicate whether the cancer has spread to other organs.
Correct Answer: C
Rationale: A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. Biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life; the three remaining statements indicate a need for patient teaching.
The nurse in the outpatient clinic is caring for a patient who smokes heavily. To reduce the patient's risk of dying from lung cancer, which of the following actions will be best for the nurse to take?
- A. Educate the patient about the seven warning signs of cancer
- B. Plan to monitor the patient's carcinoembryonic antigen (CEA) level.
- C. Discuss the risks associated with cigarettes during every patient encounter.
- D. Teach the patient about the use of annual chest x-rays for lung cancer screening.
Correct Answer: C
Rationale: Education about the risks associated with cigarette smoking is recommended at every patient encounter, since cigarette smoking is associated with multiple health problems. A tumour must be at least 0.5 cm large before it is detectable by current screening methods and may already have metastasized by that time. Oncofetal antigens such as CEA may be used to monitor therapy or detect tumour recurrence, but are not helpful in screening for cancer. The seven warning signs of cancer are actually associated with fairly advanced disease.
The nurse at the clinic is interviewing an older-adult patient who is 160 cm tall and weighs 57 kg. The patient has not seen a health care provider for 20 years. She walks 11 km most days and has a glass of wine two or three times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk?
- A. Pap testing
- B. Tobacco use
- C. Sunscreen use
- D. Mammography
- E. Colorectal screening
Correct Answer: A,C,D,E
Rationale: The patient's age, gender, and history indicate a need for screening or teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy.