ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 18 : Caring for Clients With Cancer Questions
Question 1 of 5
The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching?
Correct Answer: A
Rationale: An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months, but not in protective isolation.
Question 2 of 5
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?
Correct Answer: A
Rationale: The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.
Question 3 of 5
A client asks the nurse what is causing the fatigue following radiotherapy. What is the nurse's best response?
Correct Answer: D
Rationale: Fatigue results from substances being released when tumor cells are destroyed during radiotherapy. The spreading of cancer can cause many symptoms dependent on location and type of cancer, but it is not a significant factor in the development of fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support the presence of infection in this client.
Question 4 of 5
The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a positive biopsy?
Correct Answer: B
Rationale: The sentinel node is the first node in which a tumor will drain; if no malignant cells are found there, additional excision or radical removal will not be necessary. Excision of the lump along with a wide margin of cancer-free tissue is standard treatment for malignant tumors.
Question 5 of 5
The nurse is caring for a client with a newly discovered tumor that may be benign or malignant. The client asks, 'What makes a malignant tumor different from a benign one?' What should the nurse include in the response? Select all that apply.
Correct Answer: A,B
Rationale: The nurse should include the statements 'The cells of the tumor bear little resemblance to the cells in the tissue where the tumor started' and 'It grows by invasion and infiltrates the surrounding tissues' in the response. Undifferentiated cells and growth by invasion are both characteristics of malignant tumors. Benign tumors are characterized by slow growth, not metastasizing, and the possibility of regression, while malignant tumors are not.