Oncology Nursing

By:
DIANNE MAYDEE MANDAL RN,
USRN, REMT-B, AREMT-B
http://stuffednurse.blogspot.com

diannemaydee
LEUKEMIA

diannemaydee
• Types:
• Acute lymphocyte leukemia
- 80-85% of childhood leukemia
- Acute onset
- 95% chance of obtaining remission with
treatment
- 75% chance of surviving 5 years or more
- B. acute nonlymphocytic leukemia
- Include granulocytic and monotypic type
diannemaydee
• Acute nonlymphocytic leukemia
• Includes granulytic and monocytic type
• 30 40 % cure rate
• Assessment findings:
• Anemia
• Bleeding
• Infection
• Enlarged lympf nodes
• Enlarged spleen and liver
• Abdominal pain

diannemaydee
• 1. Danika, A child diagnosed with Leukemia has her
laboratory results available. For it to coincide with
the medical diagnosis, the nurse should not expect
which of the following systemic changes in Danika’s
hematologic system?

• A. Thrombocytopenia
• B. Anemia
• C. Petechiae
• D. Leukocytosis due to decreased WBC

diannemaydee
• 2. Procedure in diagnosing leukemia:

• A. Histamine test
• B. Schilling test
• C. platelets count
• D. bone marrow examination

diannemaydee
• 3. Common hepatomegaly manifestation
of leukemia is caused by:

• A. granulocytes
• B. lymphocytes
• C. histiocyte infiltration
• D. leukocyte infiltration

diannemaydee
• 4. She is receiving cytoxan. What is the
temporary side effect of this drug?

• A. alopecia
• B. depression
• C. dysuria
• D. blurred vision

diannemaydee
• 5. Since he is on long-term antibiotic
therapy. Which of these should you
keenly observe?

• A. developing rashes
B. developing systemic fungal
infection
• C. developing petechiae
D. developing fiber blister
diannemaydee
 Leukemia
• Pathology: abnormal proliferation of immature WBC that infiltrate
bone marrow and peripheral blood.
• IN THE BONE MARROW, BLAST CELLS crowd out healthy blood
cells
• Risk: benzene, arsenic, radiation, viral infection, genetics, Down’s
syndrome, chemotherapeutic agents.
• Dx: bone marrow biopsy
• Cardinal sign: anemia, infection, bleeding
• DOC: steroids; chemotherapy: platinol, 5-FU, oncovin, iodotope
• Nurse concern: signs of infection is absent because of
neutropenia; CNS manifestation is common in lymphocytic
leukemia; Massive amount of chemo drugs is given a one time for
Acute myelocytic leukemia; Protect from infection, bleeding and
fatigue.

stomatitis is common: oral care

discuss fears with patient and support system
diannemaydee
LUNG CANCER

diannemaydee
• General Information
- Pulmonary tumors arise in bronchial epithelium and
therefore are referred to as brocnhogenic carcinoma
- Pathologic changes include nonspecific inflammation
with hyper secretion of mucous and obstruction.
- Metastasis occurs mainly by direct extension and thru
the lymphatic system
- Men over 40 affected most and 1 of every 10 smokers
affect right lung more than left.-
- Cause by inhaled carcinogens

diannemaydee
• Medical Management
• Radiation therapy
• Chemotherapy – usually includes methotroxate,doxorubicin,
procarbazine
• Surgery when entire tumor can be removed
assessment findings:
- persisyent cough may be productive or blood tinged
- chest pain, unilateral wheezing; friction rub, possible unilateral
paralysis of the diaphragm.
-fatigue, anorexia, nausea,vommiting,pallor.
Nursing Interventions:
Provide support-pain medications
realistic information about prognosis

diannemaydee
• 4 KINDS:

• 1.Squamous cell carcinoma- most common in

men due to smoking
• 2. Aden carcinoma- lung cancer in women and
non smokers. Can be seen in alveolar parts of
the lung and usually connected with scarring
• 3. Small cell carcinoma- more on smoking
• 4. Large cell carcinoma- poor prognosis
because of their ability to metastasize

diannemaydee
• Thoracic Surgery:
• Types:
1. Exploratory thoracotomy-
2. Lobotomy
3. Pneumonectomy
4. Segmental resection
5. wedge resection-

diannemaydee
• Nursing Interventions: pre op
- Provide routine prop care
- Perform complete P.A. of the lungs as
baseline data. explain post op measures
care of incision site, O2, suctioning and
chest tubes
- Teach client adequate splinting of incision
- Demonstrate ROM on the affected side

diannemaydee
• Post OP care:
- Provide routine post op care
- Auscultator lung fields every 1-2 hrs.
- Perform suctioning when needed
- Place client in semi fowlers position
- Provide pain relief
- Prevent impaired mobility by passive exercises passive
on the day of surgery then active
- High protein diet
- Avoidance of crowds and people with resp.tract
disorders
-

diannemaydee
• 1. Mang Edgardo has a chest tube inserted in
place after a Lobectomy. The nurse knows that
that Chest tube after this procedure will:

• A. Prevents mediastinal shift

• B. Promote chest expansion of the remaining
lung
• C. Drain fluids and blood accumulated post
operatively
• D. Remove the air in the lungs to promote lung
expansion

diannemaydee
• 2. After Lobectomy, Mang Edgardo is
placed at:

• A. Affected Side
• B. Unaffected Side
• C. Left lateral position
• D. Right lateral position

diannemaydee
• 3. Extra care should be given when suctioning a patient
after Pneumonectomy. The rationale behind this is that:

• A. Suctioning could place undue strain on the bronchial

stump suture
• B. The patient will no longer have the ability to cough out
the secretions
• C. The remaining lung will not be able to compensate for
the oxygen being drawn by the suction
• D. Suctioning could cause perforation on the remaining
functioning lung

diannemaydee
 Lung CA
• Pathology: carcinogens mutate repiratory cells and
undergoes metaplasia which progresses to carcinoma

effusions, cushing’s, SIADH, DIC, anemia,
hypercalcemia, obstructions.
• Risk: Cigarette smoking
• Dx: CXR, MRI, sputum/ bronchoscopy cytology
• Cardinal sign: persistent cough, red sputum
• DOC: Mustargen ( alkylating agent)
other tx
surgery and radiation
• Nurse concern: Round the clock pain management;
Kobler-Ross grieving process&therapeutics
diannemaydee
• Lung cancer: complications
“SPEECH”
Superior vena cava syndrome
Paralysis of diaphragm (Phrenic nerve)
Ectopic hormones
Eaton-Lambert syndrome
Clubbing
Horner syndrome/ Hoarseness

diannemaydee
LARYNGEAL
CANCER

diannemaydee
 Cancer of the larynx
• Etiology
– most tumors of the larynx are squamous cell carcinoma
– more common among men, age 50 to 65
– cigarette smoking and alcohol consumption are related
• Findings
– persistent sore throat
– dyspnea
– dysphagia
– increasing persistent hoarseness
– weight loss
– enlarged cervical lymph nodes

diannemaydee
diannemaydee
 Cancer of the larynx
• Management
– radiation therapy
– chemotherapy
– surgery: removal of all or part of larynx to treat
cancer
• total laryngectomy: no voice, permanent stoma
in neck with no risk of aspiration from oral
cavity
• radical neck dissection: when cancer has
metastasized to surrounding tissues

diannemaydee
•
Cancer of
Nursing interventions
the larynx
– arrange for clients with larnygectomies to meet
with members of support groups
– establish a method for communication before
surgery
– maintain airway; have suction equipment at bedside
– observe for signs of hemorrhage or infection
– teach about trach and stoma care
– assist with period of grieving

diannemaydee
• Types:
- Supraglottic – also called extrinsic laryngeal
cancer
- Involves the epiglottis and false vocal chords
- No symptoms until advance stage
- Glottis – most frequent
- produces early symptoms
- cigarette smoking, vocal abuse, family
history.

diannemaydee
• Assessment Findings:
- Supraglottic – localized throat pain
- burning sensation when
drinking hot and cold orange juice
- lump in the neck
- eventual dysphasia,
muffled voice, dyspneic, weight loss,
cough and hemoptysis

diannemaydee
• Glottic –progressive hoarsenes. Eventual
dyspnea.
• enlarged cervical lymph nodes.
Interventions:
1. Partial laryngectomy – a lesion on the true
chord on one side is removed
- client can still talk
2. Total laryngectomy – removal of the entire
larynx, cricoid cartilage, 3-4 rings of the trachea
pharyngeal opening of the trachea is closed

diannemaydee
• - permanent tracheostomy is attached
• Result is loss of normal speech
• Loss of olfaction
• Loss of breathing
nursing care pre –op
explain expected procedures
introduce client to mode of communication like
gestures

diannemaydee
• Nursing Care post – op:
- promote optimum ventilatory status
- suction nose frequently because of allergic
rhinitis
- provide pain relief
- elevate head of bed to decrease pressure on
suture lines
- and to promote lympathic drainage
- Prevent infection
- assess non verbal communication
- need to use electric razors as the face area
will be numb for 6 months
diannemaydee
• 1. Brix has tracheostomy. When suctioning and
suctioning through laryngectomy tube. When
doing these two procedures at the same time,
the nurse would not do which of the ff:

• A. Use sterile technique

• B. turn head to right to suction left bronchus
• C. suction for no longer then 10 to 15 seconds
• D. observe for tachycardia

diannemaydee
• 2. Brix requires both nasopharyngeal suctioning
and suctioning through laryngectomy
tube. When doing these two procedures at the
same time, the nurse would not do which of the
ff:

• A. use a sterile suction setup

• B. suction the nose first, then the laryngectomy
tube
• C. suction the laryngectomy tube first, then the
nose
• D. lubricate the catheter with saline

diannemaydee
• 3. A nasogastric tube is used to provide Brix
with fluids and nutrient for approximately 10
days, for which of the following reasons?

• A. to prevent pain while swallowing

• B. to prevent contamination of the suture line
• C. to decrease need for swallowing
• D. to prevent need for holding head up to ear

diannemaydee
• 4. The client has orders for a nasogastric (NG) tube
insertion. During the procedure, instruction that will
assist in insertion would be:

• A. instruct the client to tilt his head back for insertion into
the nostril, then flex his neck for final insertion
• B. after insertion into the nostril, instruct the client to
extend his neck
• C. introduce the tube with the client’s head tilted back,
then instruct him to keep his head upright for final
insertion
• D. instruct the client to hold his chin down, then back for
insertion of the tube

diannemaydee
• 5. The nurse is correct in performing
suctioning when she applies the suction
intermittently during:

• A. Insertion of the suction catheter

• B. Withdrawing of the suction catheter
• C. both insertion and withdrawing of the
suction catheter
• D. When the suction catheter tip reaches
the bifurcation of the trachea
diannemaydee
• 6. The purpose of the cuff in
Tracheostomy tube is to:

• A. Separate the upper and lower airway

• B. Separate trachea from the esophagus
• C. Separate the larynx from the
nasopharynx
• D. Secure the placement of the tube

diannemaydee
• 7. The GAUGE size in ET tubes
determines:

• A. The external circumference of the tube

• B. The internal diameter of the tube
• C. The length of the tube
• D. The tube’s volumetric capacity

diannemaydee
• 8. The tracheostomy is attached and
secured by:

• A. Suturing it in place
• B. Tying it in place
• C. Taping it in place
• D. Inflating the cuff

diannemaydee
• 9. After a laryngectomy, a client, who is being
discharged exhibits concern that the
laryngectomy tube may become dislodged. The
nurse should teach the client to first:

• A. Notify the physician at once

• B. Reinsert another tube immediately
• C. Keep calm because there is no immediate
emergency
• D. Recognize that prompt closure of the tracheal
opening may occur
diannemaydee
• 10. In caring for a patient with a tracheostomy
which of the following would be an
INCORRECT ACTION by the nurse when
providing tracheostomy care?

• A. Checking the cuff pressure

• B. Provide humidified oxygen
• C. Remove the outer cannula for cleaning q.
shift
• D. Place sterile gauze between the outer wings
of the tube before tying strings or tape to secure
it
diannemaydee
• 11. You are assigned to teach a nursing student how to
suction an adult patient with a tracheostomy. Which of
the following actions by the nursing student would be
INCORRECT?

• A. Pre-oxygenation of the patient with a Resusibag at

100% 02 several times before suctioning
• B. Maintains wall suction pressure at 110-150mmHG
• C. Does not suction for greater than 10-15 seconds at a
time
• D. Applies gentle intermittent pressure and rotates
catheter during insertion phase of suctioning

diannemaydee
PROSTATE CANCER

diannemaydee
 Prostate Cancer
• Slow malignant change in the
prostate gland that spreads by
direct invasion of surrounding
tissues & metastasizes to the
bony pelvis & spine
• Most common site of cancer
in men (21%)
• Dihydrotestosterone – only
factor clearly associated with
development of prostate
cancer

diannemaydee
1. Incidence of prostate cancer in Asian
countries is rising rapidly as reported
by health bulletins, why is this?
a. increasing adoption of western
lifestyle
b. Promiscuous behavior of men
c. Increase in drinking & smoking
habits
d. Early detection
diannemaydee
2. With this awareness of prostate cancer,
what is the good screening method that
a nurse can suggest:

a. Annual physical check-up

b. Weight loss watching
c. X-rays & ultrasound analysis
every 2 years
d. PSA analysis once a year
diannemaydee
3. Decisions for the treatment of prostate
cancer depends on:

a. Nurse assessment advice to

patients
b. Attending physician and his
management staff
c. Pathology of the cancer & impact
on quality of life
diannemaydee
d. Age & health status of the person
4. One of the latest discovery in the
treatment of prostate cancer is:

a. Surgery
b. Anti-androgen
c. Chemotherapy
d. Radiation
diannemaydee
• Pathology: similar to BPH
• Risk: age, ethnicity, chemical exposures
• Dx: PSA more than 4.0; DRE, USG
• Cardinal sign: depends on stage:
A1= asymptomatic
B2= enlarged prostate
C3= urinary symptoms, rectal or pelvic pain
D4= ++ lymph, bone, liver, lung area pain
• \DOC: Hormone therapy and chemo-radiation Tx
Other Tx: TURP
• Nurse concern: testosterone dependent at early stage; client
will become impotent if abdominal prostatectomy is done; age
of client at diagnosis is usually 65; assess mouth for
stomatitis, for signs of dehydration, and for suicidal
tendencies; Support for body image or sexual issues.
diannemaydee
TESTICULAR
CANCER

diannemaydee
• 1. Which of the following terms refers to
surgical removal of one of the testes?

• A. Orchiectomy
• B. Circumcision
• C. Vasectomy
• D. Hydrocelectomy

diannemaydee
• Rare form of cancer
• Most common
cancer in young
men (15 – 35 y/o)
• Unknown cause
• High incidence in
cryptorchidism or
atrophic testis

diannemaydee
• Pathology: germ or stromal cell carcinoma,
seminoma replacing parenchymal tissues.
• Risk: Hx of cryptorchidism, trauma, DES exposure,
low birth weight, prematurity
• Dx: HCG, AFP, LDH
• Cardinal sign: painless, hard nodule on one side of
testes. Usual metastases on lymph, lung, bone and
GI.
• \DOC: Etopside (Vepesid) plus cisplatin chemo.
Other Tx: orchiectomy
• Nurse concern: IEC on sperm banking if client
desires fertility and on TSE.
diannemaydee
CERVICAL CANCER

diannemaydee
• 1. When the results of a Pap smear are
reported as class 5, the nurse recognizes
that the common interpretation is:

• A. malignant.
• B. normal.
• C. probably normal.
• D. suspicious. diannemaydee
• malignant.
• A class 5 Pap smear, according to the Bethesda
Classification, indicates squamous cell
carcinoma.

• normal.
• A class 1 Pap smear is interpreted as normal.

• probably normal.
• A class 2 Pap smear is interpreted as probably
normal.

• suspicious.
• A class 3 Pap smeardiannemaydee
is interpreted as
suspicious.
• 2. For women aged 19-39 years,
recommended health screening diagnostic
testing includes which of the following?

• A. Pap smear
• B. Mammography
• C. Cholesterol and lipid profile
• D. Bone mineral density testing
diannemaydee
• Pap smear
• A Pap smear is recommended for women aged 19-39
years, as well as for women aged 40 and older.

• Mammography
• Mammography is recommended for health screening
for women aged 40 years and older.
•
• Cholesterol and lipid profile
• Cholesterol and lipid profile is recommended for
women aged 40 years and older.

• Bone mineral density testing

• Bone mineral density diannemaydee
testing is recommended for
women aged 40 years and older.
• Pathology: ductal or lobular breast carcinoma
that is hormone dependent
can be in-situ or
invasive; inflammatory or Paget’s.
• Risk: family history, chest area radiation,
americans, menarche before age 12 or
menopause after 50, hormone therapy for 5
years, nulliparity, first pregnancy after 30,
never breastfed, daily alcohol use, obesity.
• Dx: mammography, BSE, fine needle biopsy.
diannemaydee
• Cardinal sign: hard irregular painless, fixed mass or
thickening in breast area; red, scaly patchy breast
skin; nipple invertion and peau d’ orange (
inflammatory).

For paget’s type: itching, burning crusting or
ulceration of nipple.
• \DOC: estrogen antagonist( tamoxifen) and other
chemo drugs.
Other Tx: Lumpectomy or mastectomy with axillary
node dissection followed by radiation.
• Nurse concern: Drainage tube care; ROM exercises;
diannemaydee
ways to prevent complications. Screening for women.
BREAST CANCER

diannemaydee
• 1. Breast self examination is an important
tool in detecting early stages of Breast
Cancer. What is being checked when
doing BSE?

• A. Thickness and Lumps

• B. Malignant or Benign Tumors
• C. Calcification of Breast
• D. Cancerous Lesions
diannemaydee
• 2. The nurse puts a folded towel under the Left
shoulder of the Client to be examined for clinical
BSE. Why is this so?

• A. To make the left shoulder nearer to the hands

of the clinician for palpation
• B. To make the pectoralis muscle prominent,
toning the breast tissue for better palpation
• C. To put the breast in a more lateral position to
better ease the palpation
• D. To balance the breast in the client’s chest to
better eases the palpation
diannemaydee
• 3. Anita is performing BSE and she stands
in front of the Mirror. The rationale for
standing in front of the mirror is to check
for:

• A. Unusual discharges coming out from

the breast
• B. Any obvious malignancy
• C. The Size and Contour of the breast
• D. Thickness and lumps in the breast
diannemaydee
• 4. An emerging technique in screening for
Breast Cancer in developing countries like
the Philippines is:

• A. Mammography once a year starting at

the age of 50
• B. Clinical BSE Once a year
• C. BSE Once a month
• D. Pap smear starting at the age of 18 or
earlier if sexually active
diannemaydee
• 5. The most common complication
associated post op mastectomy is:

• A. Hemorrhage
• B. Lymphedema
• C. Self esteem disturbance
• D. Pain

diannemaydee
• 6. Post op mastectomy, The nurse would
do the following to prevent unnecessary
injury to the Arm of the client except:

• A. BP taking from the affected arm

• B. No IM Injection to the affected arm
• C. Elevating the affected arm
• D. Preventing trauma and injury to the
affected arm
diannemaydee
• 7. Stage 3 of breast development,
according to Tanner, occurs when:

• A. the areola (a darker tissue ring around

the nipple) develops.
• B. breast budding begins.
• C. the areola and nipple form a secondary
mound on top of breast tissue.
• D. the breast develops into a single
contour diannemaydee
• the areola (a darker tissue ring around the nipple) develops.
• Stage 3 also involves further enlargement of breast tissue.

• breast budding begins.

• Breast budding is the first sign of puberty in a female.

• the areola and nipple form a secondary mound on top of breast

tissue.
• In stage 4, the nipple and areola form a secondary mound on
top of breast tissue.

• the breast develops into a single contour

• In stage 5, the female demonstrates continued development of
a larger breast with a single contour.
diannemaydee
• Pathology: squamous cell carcinoma
• Risk: low socio-economic status, early 1st marriage,
early and frequent intercourse, multiple sex partners,
high parity, poor post partum care and hygiene, HPV,
teen age smoking
• Dx: Pap smear, colposcopy, endocervical curettage,
conization, schiller’s test.
• Cardinal sign: vaginal bleeding post coital and post
menstrually; foul discharges, pelvic pain
• DOC: cisplatin; radiatio therapy
• Surgical Tx: TAH-BSO or pelvic exenteration with
permanent ileostomy or colostomy
• Nurse concern: nuns and jews have lowest
diannemaydee
incidence; IEC on annual gynecologic exam
GI neoplasm, surgery and
colostomy

diannemaydee
• 1. What is the involvement of her total gastrectomy?

• A. removal of the stomach only

• B. removal of the stomach with anastomosis of the
esophagus to the jejunum
• C. removal of the ovary and fallopian tube
• D. removal of the stomach with anastomosis of the
duodenal to jejunum

diannemaydee
• GI Neoplasm
• Pathology: proliferation of undifferentiated
GI cells.
• Risk: tobacco use ( oral ); alcohol and
tobacco ( esophageal); genetics, gastric
irritants ( stomach); low fiber, high fat,
polyps, ulcerative colitis ( intestinal ).
• Dx: guiac test, colonoscopy,
bronchoscopy, endoscopy, biopsy, barium
enema, CEA
diannemaydee
• Cardinal sign:
• Oral: leukoplakia, erythroplakia, dysphagia
• Esophageal: dysphagia, respiratory
complication
• Stomach: gastric discomfort, anorexia
• Ascending Colon: mild bleeding, anorexia,
fatigue, weight loss
• Descending colon: change in bowel habits and
stools
• DOC: chemo/radiation therapy
• Nurse concern: Standard post-op care; emotional
support

diannemaydee
• Colon cancer: risk factors
• “HULA”
Heredity/ Hereditary diseases
Ulcerative colitis
Low fiber, high fat diet
Adenomatous polyps

diannemaydee
• 2. Your operative nursing assessment after surgery:

• A. note and report excessive bleeding only

• B. assess for excessive secretions from the
operative site
• C. ensure that the NG tube is detached from suction
apparatus
• D. check the drainage from the NG tube everyday

diannemaydee
• 3. A nurse is monitoring drainage from a nasogastric
(NG) tube in a client who had a gastric resection. No
drainage has been noted during the past 4 hours and
the client complains of severe nausea. The most
appropriate nursing action would be to:

• A. reposition the tube

• B. irrigate the tube
• C. notify the physician
• D. medicate for nausea

diannemaydee
• 4. He underwent total gastrectomy, dumping
syndrome may occur and the least symptoms he
may experience would be:

• A. feeling of soreness
• B. weakness
• C. feeling of fullness
• D. diaphoresis

diannemaydee
• 5. To prevent dumping syndrome the following
includes your nursing care except:

• A. serve dry meals

• B. allow him to walk for a while after eating
• C. instruct him to lie down after eating
• D. giving of fluids after meals must be avoided

diannemaydee
• 6. Which of the following gastrointestinal condition
is known to predispose to Cancer of the colon?

• A. hemorrhoids
• B. intussusception
• C. islated colonic polyps
• D. pyloric stenosis

diannemaydee
• 7. A nurse is teaching a client about the modifiable risk
factors that can reduce the risk for colorectal
cancer. The nurse places highest priority on
discussing which of the following risk factors with this
client?

• A. personal history of ulcerative colitis or

gastrointestinal (GI) polyps
• B. distant relative with colorectal cancer
• C. age over 30 years
• D. high-fat, low fiber diet

diannemaydee
• Situation: Benjie 59 years old male was admitted to
the hospital complaining of nausea, vomiting, weight
loss of 20 lbs, constipation and diarrhea. A
diagnosis of carcinoma of the colon was made.

• 8. A sigmoidoscopy was performed as a diagnostic

measures. What position Benjie should assume for
hi examination?
• A. knee-chest
• B. Sim’s
• C. Fowler’s
• D. Trendelenburg
diannemaydee
• 9. A home care nurse visits a client with bowel
cancer who recently received a course of
chemotherapy. The client has developed
stomatitis. The nurse avoids telling the client to:

• A. drink foods and liquids that are cold

• B. eat foods without spices
• C. maintain a diet of soft foods
• D. drink juices that are not citrus

diannemaydee
• 10. A nurse has provided instructions to a client who
is receiving external radiation therapy. Which of the
following if started by the client would indicate a
need for further instructions regarding self-care
related to the radiation therapy?

• A. “I need to avoid exposure to sunlight?”

• B. “I need to wash my skin with a mild soap and pat
dry”
• C. “I need to apply pressure to the irritated area to
prevent bleeding”
• D. “I need to eat a high-protein diet”
diannemaydee
• 1. Following abdominal surgery, a client complaining
of “gas pains” will have a rectal tube inserted. The
client should be positioned on his:

• A. left side, recumbent

• B. left side, sims
• C. right side, semi-fowler’s
• D. left side, semi-Fowler’s

diannemaydee
• 2. A client who has just returned home following
ileostomy surgery will need a diet that is
supplemented:

• A. potassium
• B. vitamin B12
• C. sodium
• D. fiber

diannemaydee
• 3. The nurse instructs the ileostomy client to do
which of the following as part of essential care of the
stoma?

• A. cleanse the peristomal skin meticulously

• B. take in high-fiber foods such as nuts
• C. massage the area below the stoma
• D. limit fluid intake to prevent diarrhea

diannemaydee
• 4. The nurse has given instructions to the client with
an ileostomy about foods to eat to thicken the
stool. The nurse evaluates that the client did not fully
understand the instructions if the client stated that
eating which of the following foods makes the stool
less watery?

• A. pasta C. bran
• B. boiled rice D. low-fat cheese

diannemaydee
• 5. The client has just had surgery to create an
ileostomy. The nurse assesses the client in the
immediate postoperatively period for which of the
following most frequent complications of this type of
surgery?

• A. intestinal obstruction
• B. fluid and electrolyte imbalance
• C. malabsorption of fat
• D. folate deficiency

diannemaydee
• 6. A client is about to undergo an Abdominal
Perineal resection. An appropriate health teaching
for these clients is:

• A. Changing sterile dressing

• B. Wound care
• C. Passive ROM exercises
• D. Colostomy care

diannemaydee
• 7. The nurse is caring for a client post-operatively
following the creation of a colostomy. Which of the
ff. nursing diagnosis does the nurse include in the
plan of care?

• A. altered nutrition; more than body requirements

• B. body image disturbance
• C. fear related to poor diagnosis
• D. sexual dysnfunction

diannemaydee
• 8. The doctor performed a colostomy, post operative
nursing care include:

• A. keeping the skin around the opening clean and

dry
• B. limiting visitors
• C. withholding
• D. limiting fluid intake

diannemaydee
• 9. The nurse is teaching a client with a new
colostomy how to apply an appliance to a
colostomy. How much skin should remain exposed
between the stoma and the ring of the appliance?

• A. 1/8 inch
• B. ½ inch
• C. ¾ inch
• D. 1 inch

diannemaydee
• 10. During the irrigation of the colostomy, Benjie
complains of abdominal cramps, the nurse should:

• A. discontinue the irrigation

• B. clamp the catheter for a few minutes
• C. advance the catheter about one inch
• D. add color water

diannemaydee
• 11. If colostomy irrigation is done, the height of the
irrigator can must be how many inches above the
stoma?

• A. 14-18 inches
• B. 18-20 inches
• C. 20-24 inches
• D. 10-14 inches

diannemaydee
• 12. Which statements provided the best evidence
that a client with colostomy is adjusting to the
change in body image?

• A. the client wears loose-fitting garments

• B. the client takes a shower each day
• C. the client empties the appliance
• D. the client avoids foods that form gas

diannemaydee
• 13. The client who has undergone creation of a
colostomy has a nursing diagnosis of Body Image
disturbance. The nurse evaluates that he client is
making the most significant progress toward
identified goals if the client:

• A. watches the nurse empty the ostomy bag

• B. looks at the ostomy site
• C. reads the ostomy product literature
• D. practices cutting the ostomy appliance

diannemaydee
• 14. The client with a new colostomy is concerned
about odor from stool in the ostomy drainage
bag. The nurse should teach the client to include
which of the following foods in the diet to reduce
odor?

• A. yogurt C. cucumbers
• B. broccoli D. eggs

diannemaydee
• 15. The nurse is giving dietary instruction for the
client who has a new colostomy. The nurse
encourages the client to eat foods representing
which of the following diets for the first 4 to 6 weeks
postoperatively?

• A. high protein C. low calorie

• B. high carbohydrates D. low residue

diannemaydee
• 16. A client scheduled for colostomy surgery. An
appropriate preoperative diet will include:
• preoperative diet will include:

• A. broiled chicken, baked potato, and wheat bread

• B. ground hamburger, rice, and salad
• C. broiled fish, rice, squash, and tea
• D. steak, mashed potatoes, raw carrots, and celery

diannemaydee
• 17. Following Gastric Resection, patients are prone
to developing Dumping Syndrome. Which of the
following types of dietary intake by the patient would
be MOST helpful to either reduce or prevent this
syndrome from developing?

• A. Moderate fat, low carbohydrate

• B. High fat, high carbohydrate
• C. Low fat, low carbohydrate
• D. Moderate fat, high carbohydrate

diannemaydee
• 18. Following Total Gastrectomy patients will require
vitamin replacement. Of the following, which
vitamin is ESSENTIAL and MUST be given
throughout life:

• A. Vitamin C
• B. Vitamin B6
• C. Vitamin D
• D. Vitamin B12

diannemaydee
Bladder Cancer

diannemaydee
 Bladder Cancer
• Most common site of urinary tract cancer
• Males 50 – 70 y/o
• Unknown cause

diannemaydee
 Bladder Cancer
• Risk Factors
- smoking
- pelvic radiation
- Cyclophosphamide
- chronic cystitis
- Bladder calculi
- Schistosomiasis
- dust, fumes or dyes
- rubber, leather, paint

diannemaydee
 Bladder Cancer
Signs and Symptoms
• Painless hematuria (most common & first sign)
• Urgency, dysuria, frequency w/ small volumes
of urine
• Lumbar pain
• Asymptomatic
• Hydronephrosis
• Renal failure

diannemaydee
 Diagnostic Studies
• Urinalysis / culture
• Excretory urography
• Cystoscopy with biopsy
• Renal ultrasound
• CT Scan

diannemaydee
Surgery
Management
• Bladder resection (Cystectomy)
• Ileal conduit
- external collection device
needed
- proper fitting to prevent urine
leak to the skin
- skin care with warm water &
mild soap
• Complications:
- obstruction to urine flow via
small intestines (edema)
- infection
- stoma prolapse
- calculi
- electrolyte imbalance
diannemaydee
 Management
• Ureterostomy
- one or 2 ureters are externalized to the
abdominal wall
- ureteral stoma is created
- external collection device needed
- infection is a potential hazard
- increase fluid intake

diannemaydee
 Management
• Nephrostomy
- catheter inserted in kidney through an
incision
- to drain urine while ureteral
inflammation from trauma or calculus is
present
- assess for infection & blockage of the
catheter
- do not irrigate
diannemaydee
 Management
• Ureterosigmoidostomy
- no external collection device
- passage of flatus includes leak of urine
- infection is possible

diannemaydee
 Management
• Radiation

• Chemotherapy
- intravesical instillation with Mitomycin C
(non-invasive bladder CA)
- CMDV (Cisplatin, Methotrexate,
Doxurubicin, Vincristine)

diannemaydee
 Bladder Cancer
Nursing Care
• Allow time for client to verbalize fears of surgery,
cancer, death & body-image alterations
• Prepare bowel pre-operatively (laxatives,
antibiotics, enemas) as ordered
• Maintain patency of drainage system
• Ileal conduit care
- maintain urinary drainage bag
- cleanse skin around stoma w/ soap & water
- encourage self-care

diannemaydee
• 1. Which of the following is a sign that the
nurse could observe in acute transplant
rejection in patient after kidney transplant?

• A. Polyuria
• B. Fever and chills
• C. Weight loss
• D. Rising BUN and Creatinine more than
20%

diannemaydee
• 2. A male client who is to have a kidney
transplant asks the nurse how long will he be
taking azathioprine [ IMURAN ], cyclosporine
and prednisone. The nurse recognizes that the
client understood the teaching when he states “I
must take these medications:

• A. For the rest of my life.”

• B. Until the surgery is over.”
• C. Until the anastomosis heals.”
• D. During the post operative period.”

diannemaydee
• 3. After kidney transplant, the nurse
should observe the client for symptoms of
rejection which includes:

• A. Polyuria and jaundice

• B. Fever and weight gain
• C. Hematuria and seizures
• D. Moonface and muscle atrophy

diannemaydee
 Kidney/ Bladder Cancer
• Pathology: tumor of the kidney which metastasize in lungs,
mediastinum, bone, lymph node, liver and CNS.
• Risk: males over 50, smoking, obesity, calculi, urban
environment, industrial chemicals, analgesic abuse.
• Dx: renal USG and CT scan
• Cardinal sign: triad: gross hematuria; flank pain; and , palpable
abdominal mass.
• DOC: interferon alpha ( immunotherapy) and other chemo
drugs +++ radiation therapy.
• Surgery: Radical nephrectomy
• Nurse concern: Standard post op care. Hydrate especially
during “hot” season or exercise; Infection precaution; Void if
there’s urge or after intercourse; Avoid trauma to the
remaining kidney.
diannemaydee
• Nephrectomy: indications
4 T's:
Trauma
Tumor
TB
Transplantation

diannemaydee
 THANK YOU!!!

DIANNE MAYDEE MANDAL RN, USRN, REMT-B, AREMT-B

http://stuffednurse.blogspot.com

eye_contact_poor@yahoo.com
diannemaydeemandal@yahoo.com

This is a copy of my old supplemental slides for students

from 2 years ago, when I was just starting..only my name
has been edited, have acquired a few more name
appendages since those days =)
diannemaydee