If the client with lung cancer also has preexisting pulmonary disease, which of the following statements best describes how the extent of that can be performed?
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Solution
It may prevent surgery if the client can’t tolerate lung tissue removal.
If the client’s preexisting pulmonary disease is restrictive and advanced, it may be impossible to remove the tumor, and the client may have to be treated with on;t chemotherapy and radiation.
Which of the following is the primary goal for surgical resection of lung cancer?
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Solution
To remove the tumor and as little surrounding tissue as possible.
The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. It may be necessary to remove alveoli and bronchioles, but care is taken to make sure only what’s absolutely necessary is removed.
When a client has a lobectomy, what fills the space where the lobe was?
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Solution
The remaining lobe or lobes overexpand to fill the space.
The remaining lobe or lobes overexpand slightly to fill the space previously occupied by the removed tissue. The diaphragm is carried higher on the operative side to further reduce the empty space. The space can’t remain “empty” because truly empty would imply a vacuum, which would interfere with the intrathoracic pressure changes that allow breathing. The surgeon doesn’t use a gel to fill the space. Serous fluid overproduction would compress the remaining lobes, diminish their function and possibly, cause a mediastinal shift.
A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed?
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Solution
A small, localized area near the surface of the lung.
A small area of tissue close to the surface of the lung is removed in a wedge resection. An entire lung is removed in a pneumonectomy. A segment of the lung is removed in a segmental resection and a lobe is removed in a lobectomy.
Which of the following interventions is the key to increasing the survival rates of clients with lung cancer?
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Solution
Early detection
Early detection of cancer when the cells may be premalignant and potentially curable would be most beneficial. However, a tumor must be 1 cm in diameter before it’s detectable on a chest x-ray, so this is difficult. A bronchoscopy may help identify cell type but may not increase survival rate. High-dose chemotherapy has minimal effect on long-term survival. Smoking cessation won’t reverse the process but may help prevent further decompensation.
A centrally located tumor would produce which of the following symptoms?
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Solution
Coughing
Centrally located pulmonary tumors are found in the upper airway (vocal cords) and usually obstruct airflow, producing such symptoms as coughing, wheezing, and stridor. Small cell tumors tend to be located in the lower airways and often cause hemoptysis. As the tumor invades the pleural space, it may cause pleuritic pain. Pancoast tumors that occur in the apices may cause shoulder pain.
Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms?
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Solution
Recurrent pleural effusion
Recurring episodes of pleural effusions can be caused by the tumor and should be investigated. Dizziness, generalized weakness, and hypotension aren’t typically considered warning signals, but may occur in advanced stages of cancer.
The client with which of the following types of lung cancer has the best prognosis?
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Solution
Squamous cell
Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer. Adenocarcinoma is the next best lung cancer to have in terms of prognosis. Oat cell and small cell carcinoma are the same. Small cell carcinoma grows rapidly and is quick to metastasize.
During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease?
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Solution
Increased vascularity of the breast
Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as late menopause or a history of anovulatory cycles are associated with fibrocystic disease. Masses associated with fibrocystic disease of the breast are firm, most often located in the upper outer quadrant of the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable.
Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems?
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Solution
Ovarian cancer
Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important.