BIOLOGY 102Medical-Surgical Nursing Critical Thinking in Client Care,4th Edition CHAP 14

Medical-Surgical Nursing Critical Thinking in Client Care, 4th Edition Priscilla LeMon

CHAPTER 14

Chapter 14

1. A client is attending a health fair at work today. The client shows the nurse a new sore on the forearm that has been increasing in size and will not heal. The nurse caring for this client knows that which of the following signs could also point to a diagnosis of a malignant neoplasm?

Hint: Types of Neoplasms

Answer Choices:

1. Rapid growth, well-defined borders, and cohesiveness
2. Invasive, local, and does not stop at tissue border
3. Noncohesive, invasive, and invades and destroys surrounding tissues
4. Slow growth, well-defined borders, and encapsulated

2. A nursing student is learning about the theories of carcinogenesis. Which statement by the nursing student indicates the need for further teaching?

Hint: Theories of Carcinogenesis

Answer Choices:

1. “Oncogenes are genes that promote cell proliferation and are capable of triggering cancerous characteristics.”
2.  “Inherited cancers can become inactive by deletion or mutation.”
3.  “The theory of cellular mutation suggests that carcinogens cause mutations in cellular RNA.”
4.  “Known carcinogens include viruses, drugs, hormones, and chemical and physical agents.”

Strategy: Read each statement. Choose the incorrect statement as the correct answer, since the stem of the questions asks for an indication that further teaching is needed.

3. A college student is studying for final examinations. The student falls ill and presents to the student health center. The student is diagnosed with Epstein-Barr virus. The student has a history of smoking and recreational cocaine use, and works for a floor refinishing company part-time. Which risk factors are present in this student for developing cancer? Select all that apply.

Hint: Known Carcinogens

Answer Choices:

1. Drug use
2. Occupation
3. Age
4. Smoking
5. Viral infection

Client Need Subcategory: Prevention and/or Early Detection of Health Problems

Cognitive Level: Analysis

Objective: Explain and discuss known carcinogens, and identify risk factors for cancer.

Strategy: Consider each risk factor in the development of cancer in this client. Multiple answers will be correct.

4. A student nurse extern is working for the summer on an oncology unit. The extern’s preceptor has been explaining the characteristics of malignant cells. Which statement by the student nurse extern demonstrates a good understanding of the information?

Hint: Characteristics of Malignant Cells

Answer Choices:

1. “Malignant cells continue to perform cellular functions.”
2.  “The transformation into a malignant cell is reversible if treated promptly.”
3.  “Malignant cells rarely break away from the primary tissue site and travel to other locations.”
4.  “The work of malignant cells is simpler than that of normal cells.”

Strategy: Read each statement. Eliminate incorrect statements. Choose as the answer the statement that is correct and therefore demonstrates a good understanding on the part of the student nurse extern.

5. A client newly diagnosed with cancer is speaking to the nurse in the physician’s office. The nurse knows that because of this new diagnosis, the client might experience different physiologic and psychologic symptoms. Which effects would the nurse consider possible physiologic or psychologic effects of cancer?

Hint: Physiologic and Psychologic Effects of Cancer

Answer Choices:

1. Hyperglycemia, nephrotic syndrome, and body image concerns
2. Altered taste and smell, deep vein thrombosis, and increased leukocytes
3. Hypoglycemia, grief, and anorexia–cachexia syndrome
4. Decreased intracranial pressure, isolation, and acute pain

Client Need: Physiological Integrity

Client Need Integrity: Physiological Adaptation

Cognitive Level: Analysis

Objective: Describe physical and psychologic effects of cancer.

Strategy: Each answer has three components. Consider each component. Eliminate any answer choice with at least one incorrect component.

6. A client presents to her gynecologist’s office as follow-up to a tumor found in her left breast. Today the client will be undergoing a procedure to remove part of the large tumor by cutting through the skin. Which procedure will this client be having done today?

Hint: Table 14-9 Surgical Diagnostic Procedures

Answer Choices:

1. A fine-needle biopsy
2. A needle core biopsy
3. An incisional biopsy
4. An excisional biopsy

Objective: Describe and compare laboratory and diagnostic tests for cancer.

Strategy: Consider each procedure. Choose the procedure that is best described in the stem of the question.

7. A nursing student is studying for a pharmacology examination on chemotherapeutic agents. Which statement by the nursing student indicates the need for further teaching?

Hint: Classes of Chemotherapy Drugs

Answer Choices:

1.      “The main hormones used in cancer therapy are the corticosteroids, which are phase-specific.”

2.       “Mitotic inhibitors are drugs that act to prevent cell division during the M phase.”

3.       “Antitumor antibiotics disrupt RNA replication and DNA transcription.”

4.       “Alkylating agents basically act on preformed nucleic acids by creating defects in tumor DNA.”

8. A nurse is caring for a client undergoing brachytherapy. Which precaution should the nurse take when caring for this client?

Hint: Box 14-6 Safety Principles for Radiation

Answer Choices:

1.      Care for this client regardless of pregnancy status.

2.      Maintain the least possible distance form the client.

3.      Avoid indirect exposure with radioisotopes containers.

4.      Wear a monitoring device to measure whole-body exposure.

9. A client is admitted to the hospital with a history of squamous-cell lung cancer. Upon admission, the client exhibits signs of arm and periorbital edema. Within the hour, the client exhibits dyspnea, cyanosis, tachypnea, and an altered level of consciousness. Which action should the nurse take FIRST?

Hint: Nursing Interventions for Oncologic Emergencies

Answer Choices:

1.      Call the physician.

2.      Administer oxygen.

3.      Monitor vital signs.

4.      Initiate seizure precautions.

10. A client with renal cancer is preparing for discharge. The nurse is teaching both the client and the family about when to call for help after discharge. Which statement by the client indicates that teaching has been successful?

Hint: Box 14-13 When to Call for Help

Answer Choices:

1.      “I should call my physician if I experience new bleeding from any site.”

2.       “I should call my physician if I have an oral temperature higher than 100.5°F.”

3.       “I should call my physician if I have an episode of diarrhea.”

4.       “I should call my physician if I experience an occasional headache.”

Answer: 1

Rationale: Instruct the client or family member to call the nurse or physician if any of the following signs or symptoms occur: oral temperature higher than 101.5°F; severe headache; significant increase in pain at usual site, especially if the pain is not relieved by the medication regimen, or severe pain at a new site; difficulty breathing; new bleeding from any site; confusion, irritability, or restlessness; verbalizations of deep sadness or a desire to end life; changes in eating patterns; changes in body functioning, such as severe diarrhea or constipation; withdrawal; frequent crying; greatly decreased activity level; and the appearance of edema in the extremities or significant increase in edema already present.

Nursing Process: Evaluation

Client Need: Physiological Integrity

Client Need Subcategory: Reduction of Risk Potential

Cognitive Level: Analysis

Objective: Design an appropriate care plan for clients with cancer and their families regarding cancer diagnosis, treatment, and coping strategies.

Strategy: Look for a correct statement, indicating that client teaching has been successful.

11. A 34-year-old client, who is at her annual gynecologic examination, is being taught about early screening for breast cancer. The client has a sister and mother with a history of breast cancer. Which action by the client demonstrates good screening techniques for someone with her family history?

Hint: Box 14-10 American Cancer Society Guidelines for Cancer Screening

Answer Choices:

1.      Routine breast exams to begin after age 35

2.      Reporting of any changes in breast tissue to the health provider at the next routine visit

3.      Annual screening mammography staring at age 40

4.      Clinical breast examination every three years

Objective: Design an appropriate care plan for clients with cancer and their families regarding cancer diagnosis, treatment, and coping strategies.

Strategy: Consider screening techniques for a woman with a family history of breast cancer.

12. A student nurse is studying risk factors in developing cancer. Which client should this student nurse determine to have the highest risk of developing cancer?

Hint: Incidence and Mortality

Answer Choices:

1.      An African-American man

2.      A Native American woman

3.      A Hispanic man

4.      A Hispanic woman

13. A client with breast cancer is receiving 5-Fluorouracil (5-FU). Based on knowledge of this medication, and anticipated adverse effects or side effects, which nursing action should the nurse perform?

Hint: Table 14-10 Classifications of Chemotherapeutic Drugs

Answer Choices:

1.      Monitor ECG.

2.      Assess lung sounds.

3.      Test stool for occult blood.

4.      Encourage daily fluid intake of 2–3 liters.

Objective: Discuss the role of chemotherapy in cancer treatment, and classify chemotherapeutic agents.

Strategy: Consider each nursing action. Determine which action is needed based on potential complications of the chemotherapeutic agent 5–FU.