COCN Surgical Oncology Nursing 2 — Questions and Answers
Question 1: A patient is undergoing sentinel lymph node biopsy for breast cancer. Which statement best explains the purpose of this procedure?
- To inject chemotherapy directly into the lymphatic channels
- To stage distant metastasis throughout the body
- To remove all axillary lymph nodes for comprehensive staging
- To identify the first lymph node(s) receiving drainage from the primary tumor (Correct answer)
Correct answer: To identify the first lymph node(s) receiving drainage from the primary tumor
Sentinel lymph node biopsy identifies the first draining lymph node(s) from the primary tumor; if these are cancer-free, further axillary dissection is often avoided.
Question 2: A postoperative mastectomy patient reports feeling a tight 'cording' sensation extending down the inner aspect of her arm. The nurse recognizes this as:
- Deep vein thrombosis of the axillary vein
- Axillary web syndrome (Correct answer)
- Wound site infection
- Peripheral neuropathy from anesthesia
Correct answer: Axillary web syndrome
Axillary web syndrome (cording) is a complication of axillary lymph node surgery characterized by palpable fibrous bands extending from the axilla down the arm, causing restricted range of motion.
Question 3: After a right pneumonectomy for lung cancer, which patient position places the patient at highest risk for mediastinal shift?
- Semi-Fowler's position at 30-45 degrees
- Supine with head of bed slightly elevated
- Lying fully on the left (non-operative) side (Correct answer)
- Sitting upright in a chair
Correct answer: Lying fully on the left (non-operative) side
After pneumonectomy, lying fully on the non-operative side allows the mediastinum to shift toward the empty operative hemithorax due to gravity, potentially compromising the remaining lung.
Question 4: A patient is being discharged after total laryngectomy for laryngeal cancer. Which teaching point is most essential for patient safety?
- Avoid eating spicy foods for 6 months after surgery
- Use a standard surgical mask to protect the stoma
- Resume swimming after the surgical incision is fully healed
- Never allow water to enter the permanent stoma (Correct answer)
Correct answer: Never allow water to enter the permanent stoma
After total laryngectomy, the patient breathes exclusively through a permanent neck stoma; water entering the stoma can cause drowning because it connects directly to the trachea.
Question 5: What is the primary goal of cytoreductive (debulking) surgery in ovarian cancer management?
- To establish a definitive tissue diagnosis of the cancer
- To relieve bowel obstruction caused by pelvic tumor masses
- To reduce tumor burden to optimal residual disease to enhance chemotherapy effectiveness (Correct answer)
- To cure the cancer through complete removal of all visible disease
Correct answer: To reduce tumor burden to optimal residual disease to enhance chemotherapy effectiveness
Cytoreductive surgery aims to reduce residual tumor to less than 1 cm, which significantly improves response rates and overall survival with subsequent platinum-based chemotherapy.
Question 6: A patient with a new colostomy after sigmoid colon resection for cancer is on postoperative day 2. Which assessment finding indicates the colostomy is functioning properly?
- Bright red bleeding noted from the stoma surface
- Dark purple discoloration of the stoma mucosa
- No stool or flatus output during the first 72 hours
- Passage of flatus through the colostomy (Correct answer)
Correct answer: Passage of flatus through the colostomy
Passage of flatus through the colostomy within 24–72 hours postoperatively indicates the return of gastrointestinal motility and is an expected, reassuring finding.
Question 7: When assessing a patient's discharge readiness after colorectal cancer surgery with a newly formed ostomy, which factor is most important to verify?
- The patient has memorized all dietary restrictions related to the ostomy
- The patient can independently demonstrate proper pouching system application (Correct answer)
- A family member has agreed to manage all ostomy care for the patient
- The patient can describe all potential long-term complications of colorectal cancer
Correct answer: The patient can independently demonstrate proper pouching system application
The ability to independently demonstrate pouching system application using return demonstration confirms the patient has the skill necessary for safe self-care at home.
COCN Surgical Oncology Nursing 2
A patient is undergoing sentinel lymph node biopsy for breast cancer.
Which statement best explains the purpose of this procedure?