1.
A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse about all of these symptoms. Which one is most important to report to the health care provider?
Correct Answer
B. Dyspnea
Explanation
Dyspnea may indicate capillary leak syndrome and pulmonary edema. which requires rapid treatment. The other symptoms are common with IL-2 therapy. and the nurse should teach the patient that these are common adverse effects that will resolve at the end of the therapy.
2.
A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin’s lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient’s concerns is
Correct Answer
B. “It is possible you may have some changes in your sexual function. and you may want to consider pretreatment harvesting of sperm if you want children.”
Explanation
The impact on sperm count and erectile function depends on the patient’s pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.
3.
A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. 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. The most appropriate response by the nurse is
Correct Answer
A. “Why don’t we talk about the options you have for the care of your children?”
Explanation
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.
4.
A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse. “I have intense pain most of the time now.” The nurse recognizes that teaching regarding pain management has been effective when the patient
Correct Answer
D. Takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
Explanation
For chronic cancer pain. analgesics should be taken on a scheduled basis. with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics may also be used. there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route and the oral route is preferred.
5.
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to
Correct Answer
B. Enhance the patient’s immunologic response to tumor cells.
Explanation
IL-2 enhances the ability of the patient’s own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy. stimulate malignant cells to enter mitosis. or prevent bone marrow depression.
6.
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?
Correct Answer
B. “I rarely have the energy to get out of bed.”
Explanation
Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms. such as muscle aches and chills. are common side effects with interferon use. Patients are advised to use Tylenol every 4 hours.
7.
Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider?
Correct Answer
B. WBC count of 1700/µl
Explanation
Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy.
8.
A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient. the nurse explains that
Correct Answer
A. Hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT).
Explanation
The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT 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 required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs.
9.
The nurse teaches a patient with cancer of the liver about high-protein. high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective?
Correct Answer
C. Strawberry yogurt
Explanation
Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in calories from fat but low in protein.
10.
The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to
Correct Answer
B. Avoid presenting foods for which the patient has a strong dislike.
Explanation
The patient will eat more if disliked foods are avoided and foods that patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels. but does not address the issue of taste. Patients will not improve intake by eating foods that are beneficial but have unpleasant taste.