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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.
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The nurse is caring for a patient with ovarian cancer who is distressed because her husband rarely visits and tells the nurse, 'He just doesn't care.' The husband indicates to the nurse that 'I never know what to say to help her.' Which of the following nursing diagnoses is most appropriate?
- A. Disabled family coping related to persistently unexpressed feelings by support person
- B. Impaired home maintenance related to insufficient support system
- C. Risk for caregiver role strain as evidenced by increase in care needs
- D. Dysfunctional family processes related to insufficient problem-solving skills
Correct Answer: D
Rationale: The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest preoccupation with an outside concern as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.
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.
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.
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.
The nurse is caring for a patient who is undergoing bone marrow transplantation. Which of the following information should the nurse include in the patient's teaching plan?
- A. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone.
- B. Donor bone marrow cells are transplanted through an incision into the sternum or hip bone.
- C. The transplant procedure takes place in a sterile operating room to minimize the risk for infection.
- D. Hospitalization will be required 2-4 weeks after transplantation.
Correct Answer: D
Rationale: The patient requires strict protective isolation to prevent infection for 2-4 weeks after marrow transplantation while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room or incision required.