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The nurse is caring for a patient who is a single mother of four school-age children and is hospitalized with metastatic ovarian cancer. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. Which of the following is the most appropriate response?
- A. Why don't we talk about the options you have for the care of your children?
- B. Perhaps the children's father will take care of them when you aren't able to.
- C. For now you need to concentrate on getting well, not worry about your children.
- D. Many patients with cancer live for a long time, so it's time to plan for your children.
Correct Answer: A
Rationale: This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning 'Many patients with cancer live for a long time' and 'For now you need to concentrate on getting well' close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's ex-husband will take the children, more assessment information is needed before making plans.
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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.
Use of dental floss is contraindicated in the patient with which of the following assessment findings?
- A. Halitosis
- B. A decreased platelet count
- C. An increased white blood cell count
- D. Xerostomia
Correct Answer: B
Rationale: Use of dental floss is contraindicated in the patient that has a decreased platelet count but otherwise critical to use to enhance oral care. Halitosis, xerostomia, and an increased WBC are not contraindications for the use of dental floss.
The nurse is caring for a patient undergoing external radiation and has developed a dry desquamation of the skin in the treatment area. Which of the following patient statements indicates that the nurse's teaching about management of the skin reaction has been effective?
- A. I can buy some aloe gel to use on the area.
- B. I will expose the treatment area to a sun lamp daily.
- C. I can use ice packs to relieve itching in the treatment area.
- D. I will scrub the area with warm water to remove the scales.
Correct Answer: A
Rationale: Aloe gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.
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.
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.