1- A 52-year-old postmenopausal woman is concerned about her risk for breast cancer. Her mother and sister had the disease and were found to be BRCA2 positive. What additional factors may place the client at risk for breast cancer and should be part of the nurse’s health teaching? Select all that apply._____ A. Advanced ✗ age ✗ B. Malnutrition _____ _____ ✗ C. Alcohol consumption _____ ✗ D. Female gender _____ ✗ E. Nulliparity (no pregnancies) _____ F. Ashkenazi Jewish heritage _____ ✗ G. Late menopause _____ H. Recent hormone replacement therapy × 2- A 52-year-old postmenopausal woman is at high risk for developing breast cancer. The nurse teaches the client about the evidence-based guidelines for breast cancer screening and management. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. The client should practice __________________1_________________ and have annual Breast self-awareness ____________1_______________. A mammogram clinical Breast exam _____________1______________ should be performed by the primary health care provider as part of regular annual health examinations. Options for reducing the client’s risk for breast cancer include ____________2_____________, ____________2_____________, drug therapy and ntiestroge.am _______________2________________. tactic-880phorectomy Phrophy proph1a8-to@iiccmastecomy.a 3- A 48-year-old female client chose breast-conserving surgery and whole-breast external beam radiation therapy for her earlystage breast cancer. What health teaching would the nurse include when preparing the client for this therapy? Select all that apply._____ A. “Keep away from children while receiving therapy because you will be radioactive.” _____ ✗ B. “Avoid exposing the irradiated skin to sun to prevent burning for at least a year.” ✗ C. “Do not wash off the temporary ink markings until _____ radiation therapy is completed.” ✗ D. “Use mild soap and water to clean the irradiated area _____ during therapy.” ✗ E. “Be aware that radiation may cause fatigue and _____ changes in appetite or taste.” _____ F. “You might want to purchase a wig because of the permanent hair loss that is expected.” _____ ✗ G. “Report esophageal burning or feeling like food is ‘sticking’ after it is swallowed.” 4- A 58-year-old postmenopausal female client who had breast surgery for invasive cancer is preparing to begin chemotherapy that includes doxorubicin, cyclophosphamide, and paclitaxel (AC-T therapy). Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. The nurse would teach the client that doxorubicin, cyclophosphamide, and paclitaxel can Cardi-8 cause ___________1__________ toxicity. Therefore the client should report __________2__________ and ___________3__________ to the primary health care provider immediately. In addition, all three chemotherapeutic drugs can cause ________4____________, which places the client at risk for __________5____________ and __________5____________. Harding: Lewis’s Medical-Surgical Nursing, 11th Edition NGN Case Study Title: Cancer and Chemotherapy Scenario: A 48-year-old woman had a lumpectomy after being diagnosed with carcinoma in the left breast. She had her first chemotherapy treatment with cyclophosphamide 2 months ago. Today she is in the outpatient cancer treatment center for her sixth round of chemotherapy; radiation therapy is planned after the tenth chemotherapy treatment is completed. The nurse documents these findings as part of today’s admission assessment: • Reports “feeling tired often.” • “I have had diarrhea five or six times a day.” • “I don’t have much of an appetite.” ✗ • “I have noticed some blood in my urine, starting yesterday.” ¥ • “My food doesn’t have any taste to it at all.” • The patient has alopecia. • Oral mucosa is inflamed with some ulcerations noted in the cheek areas. • Vital signs: Temperature 100.5°F (38.1°C), Pulse 88, Respirations 12, blood pressure 118/72 1. NGN Item Type: Highlighting/Enhanced Hot Spot Highlight or place a check mark next to the assessment findings that require follow-up by the nurse. 2. NGN Item Type: Cloze Choose the most likely options for the information missing from the statement, below, by selecting from the list of options provided. The nurse recognizes that, based on the assessment data and patient’s history, the patient is currently at risk for complications, including __________, _________, and __________. Options Infection Dehydration Intestinal obstruction Hemorrhagic cystitis Pneumonitis Scenario: After further assessment, the patient indicated that she was menstruating. As a precaution, the chemotherapy treatment was postponed and the patient was scheduled for a follow-up in 1 week. At the follow-up appointment, her urinalysis was negative for red blood cells and the oncologist added immunotherapy to the treatment plan. The patient received the first dose of interferon and continued with the cyclophosphamide therapy. 1. NGN Item Type: Cloze Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. Based on the patient’s current treatment plan, the patient’s priority need will be to prevent ______1_____. Other needs that may develop in the near future include _____2_____, _____2_____, _____2_____, and _____2_____. Options for 1 Options for 2 Capillary leak syndrome Flu-like symptoms Nausea and vomiting Confusion and memory loss GI bleeding Acneiform rash Xerostomia . 2. NGN Item Type: Extended Drag and Drop Use an X (or drag and drop) to indicate which actions listed in the left column would be included in the plan of care for this patient. Nursing Actions Instruct the patient to drink small amounts of water frequently. Suggest a referral for nutritional counseling. Implementation ¥ Instruct the patient to use a firm toothbrush to ensure complete cleaning of the oral cavity. ✗ Administer antiemetics when beginning chemotherapy. Administer acetaminophen before treatment with interferons, and every 4 hours after treatment. ✗ Monitor for ECG changes and signs of heart failure. Scenario: At 10 weeks, the oncologist changed the treatment plan to include radiation therapy and continued interferon therapy. The patient will now receive external beam radiation therapy 5 days a week for 6 weeks. After the first two radiation treatments, the patient noticed that the skin around the treatment area was reddened and swollen. 1. NGN Item Type: Matrix Use an X for nursing actions listed below that are Indicated (necessary), Contraindicated (could be harmful), or Nonessential (not necessary). Only one selection can be made for each nursing action. Nursing Action Indicated Contraindicated Nonessential ✗ Apply ice packs to the affected area immediately after the radiation session. ✗ Instruct the patient to wear a brassiere to support the tissue in the area. ✗ Apply a normal saline compress to the area after the radiation session. Instruct the patient to avoid exposing the treatment area to direct sun- ✗ light. Use a medicated soap to cleanse the skin of the treatment area. Instruct the patient to wear lightweight clothing, such as cotton fabric. ✗ ✗ 2. NGN Item Type: Extended Multiple Response The nurse evaluates the effectiveness of actions. Which of the following findings indicate effectiveness? Select all that apply. ✗ _____ 1. “I will wash the affected area with a mild soap, tepid water, and a soft cloth, then pat to dry.” _____ 2. “I am going on a beach vacation next week and will work on my suntan.” _____3. “There is no redness under my breast folds, but the skin around the treatment area is slightly reddened.” ✗ _____ 4. “I plan to attend livestream church services instead of attending in person.” _____ 5. “My gums are not bleeding when I brush my teeth, and I don’t see any sores in my mouth.” _____ 6. “I will plan to get most of my housework done in the morning when I have more energy.” ✗ 7. “I will call my doctor if I have a temperature above 99°F (37.2°C).” _____ ✗ 8. “I will eat soft, nonirritating high-protein and high-calorie foods throughout the day.” _____ ✗ _____ 9. “I will wash my hands frequently and ask those around me to wash their hands.”
