Nokea
The nurse is caring for a patient with metastatic renal cell carcinoma who is receiving interleukin-2 (IL-2) as an adjuvant therapy. Which of the following mechanisms of action should the nurse teach the patient about this therapy?
- A. It enhances immunological response to tumour cells.
- B. It stimulates malignant cells in the resting phase to enter mitosis.
- C. It prevents the bone marrow depression caused by chemotherapy.
- D. It protects normal cells from the harmful effects of chemotherapy.
Correct Answer: A
Rationale: IL-2 enhances the ability of the patient's own immune response to suppress tumour cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression.
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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 caring for a patient who is receiving intravesical bladder chemotherapy. Which of the following adverse effects should the nurse monitor for in this patient?
- A. Nausea
- B. Alopecia
- C. Mucositis
- D. Hematuria
Correct Answer: D
Rationale: The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.
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.
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 nurse is caring for a patient who is receiving chemotherapy for leukemia. Which of the following observations require intervention by the nurse?
- A. The patient ambulates several times a day in the room.
- B. The patient's temperature is 38.2°C (100.8°F).
- C. The patient cleans with a warm washcloth after having a stool.
- D. The patient uses soap and shampoo to shower every other day.
Correct Answer: B
Rationale: Any temperature above 38°C (100.4°F) in a patient receiving chemotherapy should be investigated immediately. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent skin breakdown and infection.