Alopecia
A patient receiving chemotherapy with taxotere for breast cancer says, "My hair started falling out three weeks ago, and now, two months after finishing treatment, it still hasn't grown back. I thought you said it would grow back." Which response by the nurse is most appropriate?
A. "You should see your oncologist immediately — this is not expected and may indicate cancer progression."
B. "Some chemotherapy agents, including the one you received, have been associated with permanent hair loss in some patients; let's talk about how you're coping with this."
C. "Hair always grows back within one month after chemotherapy; you may not be brushing it correctly."
D. "This means your white blood cell count is still too low and your body is prioritizing infection fighting over hair growth."
Answer: B
Taxotere (docetaxel) has been reported to cause permanent hair loss in some patients, unlike most chemotherapy agents, where alopecia is temporary. The nurse should provide accurate, honest information and open the door to discussing the patient's emotional response.
A patient newly diagnosed with stage 3 lymphoma says to the nurse, "My sister died of cancer two years ago, and it was awful. I don't think I can go through what she did." The nurse observes the patient has not slept in two days and is refusing to discuss the treatment plan with the oncologist. What is the nurse's priority action?
A. Tell the patient that lymphoma has a better prognosis than the sister's cancer, so the outcome will likely be different.
B. Administer a PRN sleep aid and revisit the conversation the next day.
C. Explore the patient's specific fears and assess coping resources before further teaching about the treatment plan.
D. Proceed with the standard chemotherapy education so the patient does not fall behind on the treatment schedule.
Answer: C
This patient is showing signs of significant fear, avoidance (refusing to engage with the treatment plan), and disrupted sleep — all signs of ineffective coping that must be assessed before effective teaching can occur. Per the DeWit content, assessing coping techniques and specific fears is a core nursing responsibility before proceeding with other interventions. A minimizes the patient's fear and makes an inappropriate comparative prognosis statement. B avoids addressing the underlying fear. D disregards the patient's emotional state and pushes forward with teaching that is unlikely to be absorbed or effective — the patient isn't ready to receive it.
A patient is about to begin a chemotherapy regimen known to cause alopecia. The patient has long hair and asks the nurse what can be done to minimize distress. Which nursing actions or teaching points are appropriate? (Select all that apply.)
Suggest the patient consider cutting hair short before treatment begins to reduce distress from seeing large clumps fall out.
Inform the patient that scalp cooling caps are proven to completely prevent hair loss in all patients.
Counsel the patient to select a wig or head covering before hair loss begins.
Explain that hair loss typically begins around the second chemotherapy treatment.
Reassure the patient that regrown hair will have the identical color and texture as before.
Refer the patient to local American Cancer Society resources, which may have donated wigs available.
Answers: 1, 3, 4, 6
Cutting hair short before treatment, selecting a wig/head covering in advance, and knowing hair loss often begins by the second treatment are all supported teaching points. ACS resources for donated wigs are a legitimate referral. Option 2 is incorrect — scalp cooling may reduce hair loss but does not guarantee complete prevention, and overstating efficacy is inappropriate patient teaching. Option 5 is incorrect — regrown hair may differ in color or texture, and telling the patient otherwise sets up false expectations.
A 52-year-old patient with newly diagnosed ovarian cancer is scheduled for surgery followed by chemotherapy. The patient's spouse tells the nurse privately, "Please don't tell my wife how serious this is — I don't want her to lose hope." The patient later asks the nurse directly, "Is my cancer serious? Am I going to die?" Which nursing actions are appropriate in this situation? (Select all that apply.)
Honor the spouse's request and redirect the patient's question to the oncologist without further discussion.
Explore what the patient already understands about her diagnosis before responding.
Communicate honestly with the patient while maintaining a supportive, hopeful approach.
Discuss the conflict between the spouse's request and the patient's right to information with the healthcare team.
Tell the patient not to worry because most cancer patients survive.
Assess the patient's and family's usual coping mechanisms and offer psychosocial or spiritual care referrals.
Answers: 2, 3, 4, 6
The patient has a right to information about her own condition; the nurse should assess the patient's current understanding, communicate honestly while remaining supportive (not falsely reassuring), escalate the family conflict to the healthcare team for a coordinated approach, and assess coping/offer psychosocial-spiritual referrals as outlined in DeWit's approach to fear and ineffective coping. Option 1 inappropriately prioritizes the spouse's wishes over the patient's autonomy and right to know. Option 5 offers false reassurance, which is not therapeutic and does not reflect the patient's actual prognosis.
A patient undergoing external beam radiation to the head for a brain tumor asks the nurse whether the hair loss will be temporary, as it was during a previous course of chemotherapy for a different cancer. What is the nurse's best response, based on the pathophysiology of radiation versus chemotherapy-induced alopecia?
A. "Radiation and chemotherapy affect hair follicles in the same way, so your hair loss will likely be temporary again."
B. "Radiation to the head is more likely to cause permanent hair loss, unlike most chemotherapy-induced hair loss, which is usually temporary."
C. "Hair loss from radiation is always reversible within six months."
D. "Since you already experienced hair loss once, your follicles are now resistant to further damage."
Answer: B
Per DeWit content, radiation therapy to the scalp/head "almost always results in permanent hair loss," while chemotherapy-induced alopecia is "mostly temporary." This distinguishes the two mechanisms and directly answers the patient's comparison. A, C, and D are all factually inaccurate.
The nurse is caring for four patients with cancer. Which patient statement requires the most immediate follow-up regarding ineffective coping?
A. "I've been avoiding my friends because I don't want them to see me without my hair."
B. "I keep thinking about how my mom handled her cancer diagnosis — it gives me strength."
C. "I don't see the point of continuing treatment anymore. I've thought about how I'd end things if it gets worse."
D. "I get frustrated some days, but I try to focus on the good moments with my family."
Answer: C
This statement suggests passive suicidal ideation or hopelessness regarding continuing treatment and requires immediate further assessment for safety (crisis-level concern) — this takes priority over the other statements, which reflect more typical, expected coping responses (body image distress, drawing on family strength, situational frustration balanced with positive coping). This is a patient-safety priority question requiring the nurse to recognize a possible mental health crisis embedded within a physical illness scenario.