Nokea
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.
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When caring for a patient with a temporary radioactive cervical implant, which action by the student nurse indicates that the unit nurse should intervene?
- A. The student flushes the toilet once after emptying the patient's bedpan.
- B. The student stands by the patient's bed for 30 minutes talking with the patient.
- C. The student places the patient's bedding in the laundry container in the hallway.
- D. The student gives the patient an alcohol-containing mouthwash to use for oral care.
Correct Answer: B
Rationale: Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine or feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.
After the nurse has finished teaching a patient who is scheduled to receive external beam radiation for abdominal cancer about appropriate diet, which dietary selection by the patient indicates that the teaching has been effective?
- A. Fresh fruit salad
- B. Roasted chicken
- C. Whole wheat toast
- D. Cream of potato soup
Correct Answer: B
Rationale: To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products also should be avoided.
The nurse is teaching a patient who has a new diagnosis of acute leukemia about the complications associated with chemotherapy. The patient is restless and is looking away, never making eye contact. After the teaching, the patient asks the nurse to repeat all of the information. Based on this assessment, which of the following nursing diagnoses is most likely for this patient?
- A. Ineffective denial related to ineffective coping strategies (leukemia diagnosis)
- B. Acute confusion related to pain (infiltration of leukemia cells into the central nervous system)
- C. Anxiety related to threat of death (leukemia diagnosis)
- D. Deficient knowledge (of chemotherapy) related to insufficient interest in learning
Correct Answer: C
Rationale: The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information. The patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiological factors.
During a routine health examination, a patient tells the nurse about a family history of colon cancer. Which of the following actions should the nurse take next?
- A. Educate the patient about the need for a colonoscopy at age 50.
- B. Teach the patient how to do home testing for fecal occult blood.
- C. Obtain more information from the patient about the family history.
- D. Schedule a sigmoidoscopy to provide baseline data about the patient.
Correct Answer: C
Rationale: The patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning.
External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient which of the following important measures to help prevent complications from the effects of the radiation?
- A. Test all stools for the presence of blood.
- B. Maintain a high-residue, high-fibre diet.
- C. Clean the perianal area carefully after every bowel movement
- D. Inspect the mouth and throat daily for the appearance of thrush.
Correct Answer: C
Rationale: Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.