following shift report on an oncology unit, which patient would the nurse assess first?

Which unit does the nurse receive the change of shift report?

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? ANS: C Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first.

Where does the nurse receive change of shift report for lung cancer?

The other findings also require intervention, but are common in patients with lung cancer and not immediately life threatening. The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?

Are the diagnoses and clinical manifestations of other patients immediately life threatening?

The diagnoses and clinical manifestations for the other patients are not immediately life threatening. A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?

What does the nurse observe the client doing during perineal care?

The nurse observes the student providing oral hygiene and perineal care. C. The student teaches the client that symptoms of neutropenia include fatigue and weakness. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected. Asepsis with IV lines is an appropriate action.

Which patient would the nurse need to assess first after change of shift report?

The nurse has received the shift report. Which client should the nurse assess first? Assess the client for abnormal bleeding.

Which action be most appropriate for the clinic nurse who suspects another staff nurse of stealing narcotics from the clinic?

Which action would be most appropriate for the clinic nurse who suspects another staff nurse of stealing narcotics from the clinic? Notify the director of nurses immediately.

Which potential side effect would the nurse include in the teaching plan for a patient undergoing radiation therapy for laryngeal cancer?

Radiation therapy to the head and neck can cause side effects that make it difficult to take in adequate amounts of food and fluids. These side effects include loss of appetite, changes in taste or loss of taste, painful chewing and swallowing, mouth sores, dry mouth and nausea.

When caring for the patient with chemotherapy induced mucositis which intervention will be most helpful?

Preventive measures for chemotherapy-induced mucositis include: Brushing with a soft toothbrush twice a day, flossing daily, and rinsing with bland solutions, such as normal saline, sodium bicarbonate, or tap water, at least four times a day are recommended.

What is the role of the nurse manager when a nurse is suspected of substance abuse?

The nurse manager's role in the process of removing the nurse from patient care is essential. Removal from practice will assist the nurse in focusing on care and treatment of the disorder, but more importantly, the earlier SUD is identified and the nurse is removed from patient care, the sooner patients are protected.

What is diversion in Nursing?

Drug diversion occurs when medication is redirected from its intended destination for personal use, sale, or distribution to others. It includes drug theft, use, or tampering (adulteration or substitution). Drug diversion is a felony that can result in a nurse's criminal prosecution and loss of license.

What side effects does chemotherapy have?

Here's a list of many of the common side effects, but it's unlikely you'll have all of these.Tiredness. Tiredness (fatigue) is one of the most common side effects of chemotherapy. ... Feeling and being sick. ... Hair loss. ... Infections. ... Anaemia. ... Bruising and bleeding. ... Sore mouth. ... Loss of appetite.More items...

What are the side effects of radiation to the breast?

Side effects of radiotherapySkin reactions.Swelling of the breast.Pain in the breast or chest area.Hair loss in the armpit.Sore throat.Tiredness and fatigue.Lymphoedema.Change in breast shape, size and colour.More items...

What is the best way for the nurse to assess the nutritional status of a patient with cancer?

The simplest way to assess nutritional status is to monitor a patient's weight loss, Rogers said, and validated screening tools, including Nutritional Risk Screening and Scored Patient-Generated Subjective Global Assessment, have been shown to improve outcomes.

How do you manage mucositis?

Dobrush your teeth with a soft toothbrush at least twice a day.gently floss once a day if you can.rinse your mouth with warm water (or water mixed with a bit of salt) several times a day.suck on crushed ice or ice lollies.eat soft, moist foods, like soup, jelly or soft fruit, or try adding gravy or sauces to meals.More items...

How do you prevent chemo mucositis?

Allopurinol mouthwashes 4 to 6 times per day have been evaluated as prophylaxis against mucositis resulting specifically from the action of 5- fluorouracil chemotherapy. Results of the meta-analysis support the use of allopurinol mouthwash to prevent mucositis.

When does mucositis occur after chemo?

Mucositis tends to appear sooner after chemotherapy than after radiotherapy, and more often affects the non-keratinized mucosa (2). Its maximum expression occurs 7-10 days after chemotherapy, and erythema progresses towards ulceration.

After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/μL after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) d. Patient who is worried about getting the prescribed long-acting opioid on time

ANS: C Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The...

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patient's self-esteem? a. Tell the patient to limit social contacts until regrowth of the hair occurs. b. Encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss. d. Inform the patient that hair usually grows back once the chemotherapy is complete.

ANS: B The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at...

During a routine health examination, a 40-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Teach the patient about the need for a colonoscopy at age 50. b. Teach the patient how to do home testing for fecal occult blood. c. Obtain more information from the patient about the family history. d. Schedule a sigmoidoscopy to provide baseline data about the patient.

ANS: C The patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment. The other actions may be a...

During the teaching session for a patient who has a new diagnosis of acute leukemia the patient is restless and is looking away, never making eye contact. After teaching about the complications associated with chemotherapy, the patient asks the nurse to repeat all of the information. Based on this assessment, which nursing diagnosis is most appropriate for the patient? a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy b. Acute confusion related to infiltration of leukemia cells into the central nervous system c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis d. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment

ANS: C The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and r...

External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.

ANS: C Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this...

The home health nurse cares for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."

ANS: B Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side ef...

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? a. The patient ambulates several times a day in the room. b. The patient's visitors bring in some fresh peaches from home. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

ANS: B Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulat...

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a. IL-2 enhances the immunologic response to tumor cells. b. IL-2 stimulates malignant cells in the resting phase to enter mitosis. c. IL-2 prevents the bone marrow depression caused by chemotherapy. d. IL-2 protects normal cells from the harmful effects of chemotherapy.

ANS: A 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 cause...

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.

ANS: B Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly t...