Oncological Disorder (Q)

ONCOLOGICAL DISORDER

SITUATION I

You're a team leader nurse for the evening shift in a 30-bed long-term care facility. Your staff in the evening includes an LPN, RN, and three orderlies/PAB. During the change of shift, you receive a report about the patient. Mr. C is a 68-year-old man who has chronic kidney disease, coronary artery disease, and chronic obstructive pulmonary disease (COPD). He is currently complaining of shortness of breath and is receiving oxygen at 2 L/min via nasal cannula. His latest oxygen saturation is 85 %, you immediately notified the physician.see answer

The physician’s orders for Mr. C include the following:

-Take a sputum sample for culture and sensitivity testing.

-Have the patient use incentive spirometry every 2 hours.

-Check SpO2 every 4 hours.

-Administer levofloxacin (Levaquin) 250 mg by mouth (PO) every 8 hours.

Question 1:

Who is the best person that would be appropriate to delegate in carrying out these physician’s orders?see answer

Physician and nursing orders to other patients:

1. Check the patient for liquid stools at least every two hours.

2. Reorient the patient to time, date, and place as needed.

3. Administer diphenoxylate (Lomotil) 5mg PO every 6 hours until liquid stools resolve.

4. Give ciprofloxacin (Cipro) 250 mg PO every 12 hours for 3 days.

5. Obtain a urine sample for culture and sensitivity.

6. Obtain a stool sample for ova and parasite testing.

7. Perform a catheter care every shift (draining catheter bag) and record the output.

8. Monitor oxygen saturation and adjust oxygen as needed.

Question 2:

Which orders will you assign to the orderly/PAB, RN, and LPN? Do not repeat your answers.

RN:

LPN:

PAB:

SITUATION II

A patient admitted for a CHF is now stable. Patient care task today: Teaching about food high in sodium, recording intake and output, explain the importance for alternating rest periods with exercise to the patient and family, advise patient about limiting foods high in salt and fluid, assisting during ambulation, and monitoring if the patient complains of chest pain.

see answer

Question 1:

Appropriate activities to assign to PAB would include all of the following tasks except what?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

SITUATION III

Family members are encouraging your patient to “tough out the pain” rather than risk drug addiction to narcotics. The client is stoically abiding. You recognize that the sociocultural dimension of pain is the current priority for the client.see answer

Question 1:

What question will you ask the patient?

1. _____________________________________________________________________________________________________________________________.

The next day the patient is crying and grimacing but denies pain and refuses pain medication, he states, “My sibling is a drug addict and has ruined our lives.”

Question 2:

What is your priority intervention for this patient?

1. _____________________________________________________________________________________________________________________________.

SITUATION IV

You're caring for a young man with a history of substance abuse who had exploratory abdominal surgery 4 days ago for a knife wound. There is an order to discontinue the PCA-delivered morphine and to start oral pain medication. The patient begs, "Please don't stop the morphine. My pain is really a lot worse today than yesterday."see answer

Question 1:

What is your best response?

1. _____________________________________________________________________________________________________________________________.

SITUATION V

You're caring for a patient with esophageal cancer. Which task could be delegated to the PAB? Encircle your answer:

1. Initiating daily weightings. 3. Facilitating expression of grief and anxiety.

2. Observing the patient response to feeding. 4. Assisting the patient with oral hygiene.

see answer

SITUATION VI

Which members of the health care team (MD, RN, LPN/LVN,PAB) should perform the tasks related to the care of patients who are at risk for breast cancer?see answer

1. Perform the clinical breast examination._____________.

2. Teach about breast self-examination. _______________.

3. Make a nursing diagnosis based on the assessment data. ____________.

4. Assess the patient’s belief about and use of complementary and alternative therapies. ___________.

5. Reinforce the importance of a baseline screening mammogram starting at age 40. ___________.

6. Explain the results of the mammogram to the patient.___________.

SITUATION VII

The patient's wife is watching as the nurse prepares to insert a small bore feeding tube. She asks the nurse, "What is the purpose of the guide wire?"see answer

Question 1:

The nurse correctly responds:

1. _____________________________________________________________________________________________________________________________.

The patient begins to cough and choke as the nurse is inserting the NG tube.

Question 2:

What is the best action by the nurse this time?

1. _____________________________________________________________________________________________________________________________.

The nurse successfully had inserted the NG feeding tube. The patient vomited during insertion and continues to gag.

Question 3:

What actions should the nurse take apart from notifying the doctor for possible X-ray?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

The next day on your shift, the patient became confused and pulling at her NG tube. As you retape the tube to the bridge of the patient's nose, you notice that the mark on the tube has moved away from the naris.

Question 4:

What action should you take?

1. _____________________________________________________________________________________________________________________________.

You have another patient who had an NG feeding tube inserted 1 week ago. You notice that the patient's nasal mucosa is inflamed, and the patient complains of pain at the site of insertion. The another naris appears patent with intact skin.

Question 5:

What is the best action to take at this time?

1. _____________________________________________________________________________________________________________________________.

Question 6:

What is the sequence of the procedure for verifying feeding tube placement?
_A) Measure pH of aspirate. Compare the color of the strip with the color on the chart provided by the manufacturer.
_B) Discard used supplies, remove gloves and discard, and perform hand hygiene.
_C) Draw back on the syringe and obtain 5 to 10 mL of gastric aspirate. Observe appearance of aspirate.
_D) Perform hand hygiene. Apply clean gloves. Draw up 30 mL of air into syringe, then attach to the end of the feeding tube. Flush tube with 30 mL of air.

SITUATION VIII

The physician orders 2 units of packed RBCs to be administered to the patient. The nurse has obtained the unit of blood from the blood bank and has checked the blood bag properly with another nurse. At 0600, the night shift nurse will initiate the first unit's transfusion before going off shift.see answer

Question 1:

Just before the beginning of transfusion, what should the night shift nurse do?

1. _____________________________________________________________________________________________________________________________.

At 1000, you note that the IV line has clotted off and the transfusion has not been completed. Your assessment revealed that the transfusion was only approximately 75% complete.

Question 2:

What is your most appropriate action?

1. _____________________________________________________________________________________________________________________________.

SITUATION IX

The nurse enters the patient's room to assess the patient who began receiving a blood transfusion 45 minutes earlier, and notes that the patient is flushed and dyspneic. On assessment, the nurse auscultates the presence of crackles in the lung bases.see answer

Question 1:

The nurse determines that this patient most likely is experiencing which complication of blood transfusion therapy?

1. _____________________________________________________________________________________________________________________________.

SITUATION X

You are working in a blood bank facility procuring units of blood from donors.see answer

Question 1:

Which client would not be a candidate to donate blood?
1.The client who had wisdom teeth removed a week ago.

2.The nursing student who received a measles immunization 2 months ago.

3. The mother with a six (6)-week-old newborn.

4.The client who developed an allergy to aspirin in childhood.

SITUATION X

You're preparing to initiate a blood transfusion. The patient has a peripheral intravenous infusion in the left arm of potassium chloride in Lactated Ringers and 5% Dextrose with a doctor's order not to stop it and adjust the rate. You start to prepare another line in the right arm. The patient begs you to use the existing site to avoid the trauma of having another line started.see answer

Question 1:

What will be your appropriate response?

1. _____________________________________________________________________________________________________________________________.

When checking a patient's I.V. insertion site at the left arm, you note normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When you lower the I.V. fluid bag, no blood returns to the tubing.

Question 2:

What is your intervention?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

SITUATION XI

The nurse on a medical unit is making rounds after receiving the shift report. Which client should the nurse see first? Rank in order of priority. Put a number on your answer:see answer

___A. The 45-year-old client who complained of having chest pain at midnight last night and received NTG sublingually.

___B. The 62-year-old client who is complaining that no one answered the call light for 2 hours yesterday.

___C. The 29-year-client diagnosed with septicemia who called to request more blankets because of being cold.

___D. The 78-year-old client diagnosed with dementia whose daughter is concerned because the client is more confused today.

___E. The 37-year-old client who has a Stage 4 pressure sore and the dressing needs to be changed this morning.

SITUATION XII

Mrs. D,age 32, sustained a traumatic brain injury after a ski accident. She is conscious and is wearing a flexible Naso-enteric tube. Intermittent tube feeding is to be administered q 4x a day. It is 10:45 and you are about to administer the 11:00 tube feeding.see answer

Question 1:

What will you assess to check the correct placement of the tube?

1. _____________________________________________________________________________________________________________________________.

Question 2:

How will you maintain the patency of the tube?

1. _____________________________________________________________________________________________________________________________.

SITUATION XIII

Mrs. A is a 51-year-old woman with late stage ovarian cancer. She is a single mother with five children.

She recently phoned the team saying that she felt very unwell and tired and for that, she would like to come into the hospital as she thought she might be dying.see answer

Together with her eldest child and the health care team, it has been decided that the patient will receive comfort care with DNR order and that intravenous infusions will be discontinued.

MEDICAL ORDERS

Fentanyl patch 27 mcg Change position q 2 h

Morphine 5mg subq via butterfly Colace 20 mL P.O

Gravol 100 mg cap. L.A P.O PRN Oxygen 2-3L PRN

Question 1:

What other important comfort care should be planned for Mrs. A?

1. _____________________________________________________________________________________________________________________________.

The following days, she noticed that her mom’s condition is deteriorating. She asked you to stop giving morphine to Mrs.A. She states, “My mom will die sooner because of that medication.”

Question 2:

What explanation will you give to the eldest child to help her understand the purpose of using morphine for her mom?

1. _____________________________________________________________________________________________________________________________.

SITUATION XIV

You're working in an oncology unit, you have a patient in the terminal stage of cancer is being transferred to hospice care.

see answer

Question 1:

What information should you include in the teaching plan regarding hospice care?

1. _____________________________________________________________________________________________________________________________.

A patient receiving chemotherapy for breast cancer develops myelosuppression.

Question 2:

What instructions should the nurse include in the discharge teaching plan?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

SITUATION XV

After having a lobectomy for lung cancer, the patient receives a chest tube connected to a three-chamber chest drainage system.see answer

Question 3:

What do you observe when the drainage system is functioning correctly?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

See answers