Abrams Chapter 14 - NCLEX

A nurse is providing education to a client who is preparing to begin chemotherapy for the treatment of cancer. What action should the nurse encourage the client to implement to minimize the effects of chemotherapy-triggered mucositis? A. ''Self-administer 650 mg of acetaminophen 4 times daily.'' B. ''Thoroughly rinse your mouth often, especially before and after meals.'' C. ''Limit fluid intake to prevent overhydration of mucous membranes.'' D. ''Gargle with a commercial mouthwash 3 to 4 times daily.''

B. ''Thoroughly rinse your mouth often, especially before and after meals.'' A client who is experiencing mucositis should rinse the mouth several times daily, especially before meals (to decrease unpleasant taste and increase appetite) and after meals (to remove food particles that promote growth of microorganisms). Fluid intake should be increased, and commercial mouthwashes should be avoided. Analgesia therapy is usually topical, rather than oral.

A nurse in an outpatient treatment center is caring for a client who receives regular IV chemotherapy sessions. The nurse understands that one important goal of chemotherapy is what? A. Prevention or treatment of adverse drug effects B. Promotion of uncontrolled cell growth C. Decrease in biologic targeted therapies D. Inhibition of normal cell production

A. Prevention or treatment of adverse drug effects Drugs used in oncologic disorders include those used to kill, damage, or slow the growth of cancer cells, and those used to prevent or treat adverse drug effects. Cancer cells demonstrate uncontrolled cell growth; normal cells grow in a controlled fashion. Biologic targeted therapies are a newer group of anticancer medications.

What potential benefit is unique to biologic agent therapies? A. They may affect cancer cells while leaving normal body cells unaffected. B. Cytotoxic adverse effects are rarely experienced. C. Administration does not require a certified chemotherapeutic nurse. D. They may be administered long term without the need for regular blood work.

A. They may affect cancer cells while leaving normal body cells unaffected. Biologic agents target cellular differences between the malignant and normal cells. Consequently, they may kill cancer cells while leaving normal body cells unaffected. Like all drugs, they have adverse effects. They require exceedingly careful administration and necessitate close monitoring by specially trained staff.

Malignant neoplasms are classified according to the type of tissue involved and other characteristics. What are examples of hematologic malignancies? Select all that apply. A. Angiosarcoma B. Leukemias C. Multiple myeloma D. Osteogenic sarcoma E. Lymphomas

B. Leukemias C. Multiple myeloma E. Lymphomas Hematologic malignancies involve the bone marrow and lymphoid tissues; they include leukemias, lymphomas, and multiple myeloma. Carcinomas and sarcomas are solid neoplasms, which are composed of a mass of malignant cells and a supporting structure of connective tissue, blood vessels, and lymphatics.

The nurse is caring for a client who is undergoing chemotherapy for the treatment of leukemia. The nurse should monitor the client for what potential adverse effects? Select all that apply. A. Increased urine output B. Mucositis C. Hypouricemia D. Unusual fatigue E. Tetany

B. Mucositis D. Unusual fatigue E. Tetany Common adverse effects of cytotoxic drug administration include mucositis and fatigue. With treatment of leukemias and lymphomas, an adverse effect called tumor lysis syndrome may occur; effects of this disorder include paresthesias, tetany, decreased urine output, and hyperuricemia.

What is the defining characteristic of a sarcoma? A. Congenital in nature B. Originates from connective tissue C. Attributable to endogenous carcinogens D. Sequestered within bone or muscle tissue

B. Originates from connective tissue Sarcomas are derived from connective tissue such as muscle, bone, cartilage, fibrous tissue, fat, or blood vessels. They are not sequestered within other tissues, and they are not the result of endogenous carcinogens. Sarcomas are not a congenital health problem.

A recent nursing graduate is receiving special training to become certified in handling and administering chemotherapy drugs. This special training is necessary because of what nursing diagnosis among clients receiving chemotherapy? A. Risk for acute pain related to chemotherapy B. Risk for injury related to chemotherapy C. Risk for ineffective health maintenance related to chemotherapy D. Risk for contamination related to chemotherapy

B. Risk for injury related to chemotherapy Because of the toxicity of chemotherapeutic agents, nurses who administer intravenous cytotoxic chemotherapy receive special training and are certified in handling and administering the chemotherapy drugs safely and accurately. Incorrect administration creates a serious risk for injury. Pain, contamination, and impaired health maintenance are not directly associated with incorrect administration.

The nurse is providing education to a client diagnosed with metastatic cancer. What treatment will the nurse indicate is likely necessary? A. Combination of surgery and radiation therapy B. Systemic chemotherapy C. Localized chemotherapy and concurrent radiation therapy D. Radiation

B. Systemic chemotherapy Localized tumors are often treatable with surgery, radiation, or chemotherapy combined with radiation (concurrent) therapy. Metastatic disease requires systemic chemotherapy.

The community health nurse is planning care for a client who will be prescribed an oral chemotherapy drug for the next several months while recovering at home. What health education topic should the nurse emphasize? A. Ways to match the dose to the severity of the symptoms B. Techniques for safely handling the drug C. Appropriate herbal substitutes for the chemotherapy agent D. Techniques for self-monitoring of liver status

B. Techniques for safely handling the drug All cytotoxic drugs are hazardous substances and require special handling and disposal, per safety guidelines, in the home. It is not possible for the client to independently monitor liver status in the home. Herbal substitutes for chemotherapy drugs do not exist, and doses are not adjusted based on short-term symptoms.

The nurse is describing the necessity of recovery periods between treatment cycles to a client receiving chemotherapy. How should the nurse best explain the need? A. ''The restoration of fluid balance and nutrition is needed before continuing with chemotherapy.'' B. ''There is a need to restore a physiologic reserve of energy before further chemotherapy.'' C. ''Time is needed to replace many of the healthy body cells killed by chemotherapy.'' D. ''Time is required for the successful application of radiation therapy between cycles of chemotherapy.''

C. ''Time is needed to replace many of the healthy body cells killed by chemotherapy.'' Cyclic administration involves taking the drugs for a specific period, with a recovery period following each treatment cycle. The recovery period allows time for the client to produce new, healthy cells to replace the normal rapidly dividing cells that have been affected by the drugs. Recovery time is unrelated to energy reserves, fluid balance, and nutrition. Recovery time does not necessarily correspond to the schedule for radiation therapy; not every client who receives chemotherapy will receive radiation therapy.

A nurse educator is discussing the role of protooncogenes in the pathophysiology of cancer. What typically triggers protooncogenes to differentiate into oncogenes? A. Ischemia B. Exposure to chemotherapeutic agents C. Exposure to carcinogens D. Exposure to a low-pH environment

C. Exposure to carcinogens When normal growth-regulating genes (protooncogenes) are exposed to carcinogens, they may undergo genetic alteration and become oncogenes. This can stimulate continuous cell growth, allowing abnormal, disordered, and unregulated cell replication. Exposure to the other factors does not result in this alteration.

The nurse is providing medication education to a client with breast cancer who has been prescribed tamoxifen. How should the nurse explain the action of the drug? A. Increases the viability of healthy cells that are adjacent to cancerous cells B. Causes mutations of cancer cells C. Slows the growth of cancer cells D. Induces apoptosis of cancer cells

C. Slows the growth of cancer cells Antineoplastic hormone inhibitors slow the growth of cancer cells. They do not treat cancer by causing apoptosis (cell repair) or mutations. They do not influence healthy body cells in the area of the tumor.

The dosages of the chemotherapy agents that will be administered are based primarily on what client variable? A. Body surface area (BSA) B. Percentage of body water C. Weight D. Comorbidities

C. Weight It is important to use weight-based dosing to individualize dosing of all cytotoxic drugs to minimize toxicity of normal cells. Considerations such as comorbidities, BSA, and percentage of body water may be relevant for certain clients, but weight-based dosing is the norm.

The nurse is assessing a client for adverse effects related to methotrexate therapy. What diagnostic finding should the nurse prioritize? A. Electrocardiogram (ECG) B. Calcium and magnesium levels C. Serum osmolality D. Creatinine clearance

D. Creatinine clearance Methotrexate is nephrotoxic. Consequently, the nurse must carefully follow indicators of the client's renal function. Electrolyte and water disturbances and cardiac conduction disorders are much less likely adverse effects.

The normal growth-regulating genes that are present in all cells are referred to by what name? A. Neoplastic transformations B. Carcinogens C. Oncogenes D. Protooncogenes

D. Protooncogenes Abnormal genes, called oncogenes, are mutations of normal growth-regulating genes called protooncogenes, which are present in all body cells. Carcinogens are cancer-causing agents. Neoplastic transformation is a process in which replication of abnormal cells occurs without normal immune destruction.

Mutation in what gene results in more than 90% of small cell lung cancers and more than 50% of breast and colon cancers? A. a42 B. c42 C. a53 D. p53

D. p53 Mutations of the p53 gene, a common genetic change in cancer, are associated with more than 90% of small cell lung cancers and more than 50% of breast and colon cancers. All other choices are incorrect.

The nurse is preparing an infusion of a monoclonal antibody for a client undergoing treatment for cancer. Before administering the infusion, the nurse confirms the order for premedication using what drug? A. Acetaminophen B. Acetylsalicylic acid C. Ibuprofen D. Naproxen sodium

A. Acetaminophen To prevent or decrease infusion reactions, infusion of monoclonal antibodies is frequently preceded by administration of premedication with diphenhydramine and acetaminophen. Acetylsalicylic acid, naproxen sodium, and ibuprofen are not indicated.