Cellular Regulation
A client with Hodgkin disease is started on chemo.. The nurse teaches the client to notify the HCP to seek treatment for which adverse response of chemotherapy? A. Hair loss B. Sores in the mouth C. Moderate diarrhea after treatment D. Nausea for 6 hr after treatment
B. Stomatitis is a common response to chemotherapy and should be brought to the HCP's attention because a swish-and-swallow anesthetic solution can be prescribed to make the client more comfortable. Hair loss is also anticipated with some chemotherapeutic drugs; the effects are temporary and reversible. Moderate diarrhea is expected and is not a cause for concern unless dehydration results. Nausea is expected but should be reported if it lasts more than 24 hrs.
A client who has been diagnosed with acute lymphocytic leukemia will be receiving doxorubicin infusions as part of a chemotherapy regimen. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred? A. Alopecia B. Dyspnea C. Metallic taste to food D. Cardiac rhythm abnormalities
D. Doxorubicin is cardiotoxic, which is manifested by transient ECG abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.
What is a nurse's most important consideration when formulating a plan of care for a school-aged child undergoing chemotherapy? A. Preventing infection B. Increasing caloric intake C. Limiting nausea and vomiting D. Monitoring hematoma formation
A. Chemotherapy suppresses the immune system; the child is in danger of contracting an overwhelming infection. Although increasing caloric intake is important, it is not the priority. Although nausea and vomiting are side effects of chemotherapy, they can be minimized with appropriate pharmacological therapy. Although it is important to check for hematomas, it is not as important as preventing infection; gentle handling helps prevent hematomas.
A client is to receive metoclopramide IV 30 min before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for what purpose? A. Stimulate production of GI secretions B. Enhance relaxation of the upper GI tract C. Prolong excretion of the chemotherapeutic medication D. Increase absorption of the chemotherapeutic medication
B. The relaxation effect increases the passage of food through the GI tract, limiting reverse peristalsis, gastroesophageal reflux, and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of GI secretions; it has no effect on the excretion of chemotherapeutic medications; and has no effect on the absorption of chemotherapeutic medications.
An adolescent with leukemia is to be given a chemotherapeutic agent that is known to cause nausea and vomiting. When is the best time for the nurse to administer the prescribed antiemetic? A. Before each dose of chemotherapy B. As nausea occurs C. 1 hr before meals D. Just before each meal is eaten
A. The purpose of an antiemetic before chemotherapy is to prevent the child from experiencing nausea during and after the administration of the medication. Waiting until nausea has occurred is too late; the medication should be given before nausea occurs. The meals are not causing the nausea; the nausea is caused by the chemotherapy, and if nausea is not prevented, the child will not eat.
A client who is receiving combination chemotherapy for stage II Hodgkin disease is at risk for stomatitis. Which information should the nurse include in the teaching plan? A. "Rinse the mouth 3x a day with lemon juice and water" B. "Brush the teeth once daily and use dental floss after each meal" C. "Clean the mouth with a soft toothbrush or a gentle spray" D. "Gently clean the mouth with commercial mouthwash"
C. Chemotherapy destroys the rapidly dividing cells of the oral mucosa; frequent gentle oral hygiene limits additional trauma. Although it is recommended to rinse the mouth every 2 hours, the client does not need to brush teeth and clean the mouth as often. Lemon juice is too caustic to the compromised mucosa. Flossing can disrupt and traumatize the gum surfaces; oral hygiene is needed more than once a day. Commercial mouthwashes contain alcohol, which is irritating to the mucosa.
A nurse is obtaining a health hx from the parents of a toddler who has recently been diagnosed with acute lymphocytic leukemia. Which early physiologic changes does the nurse expect the parents to report? Select all that apply. A. Pale skin B. Loss of hair C. Eating less food D. Sores in the mouth E. Purplish spots on the skin
A, C, E. Pallor is a presenting sign of leukemia and reflects anemia because of decreased erythrocytes. Lack of appetite (anorexia) resulting in the consumption of less food is a presenting symptom of leukemia; it may be the result of enlarged lymph nodes and areas of inflammation in the intestinal tract. Decreased platelet production with petechiae and bleeding is a presenting sign of leukemia. Alopecia results from chemotherapy, not the leukemia. Sores in the mouth are not a presenting sign but often result from chemotherapy.
A client is admitted to the hospital with pancytopenia as a result of chemotherapy. What should the nurse plan to teach this client in an effort to minimize the risk of complications as a result of pancytopenia? A. Avoid traumatic injuries and exposure to infection B. Perform frequent mouth care with a firm toothbrush C. Increase oral fluid intake to a minimum of 3 L daily D. Report any unusual muscle cramps or tingling sensations in the extremities
A. Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase susceptibility to infection. Aggressive oral hygiene can precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic by-products of chemotherapy, this has no effect on pancytopenia. Muscle cramps or tingling sensations in the extremities are adaptations to hypocalcemia; hypocalcemia is unrelated to pancytopenia.
A client is diagnosed with acute lymphoid leukemia and is receiving chemotherapy. The nurse should monitor what thrombocytopenic side effects of chemotherapy? Select all that apply. A. Nausea B. Melena C. Purpura D. Diarrhea E. Hematuria
B, C, E. Black, tarry feces (melena) caused by the action of intestinal secretions on blood are associated with bleeding in the GI tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes. Blood in the urine (hematuria) may occur. Nausea and vomiting are not related to thrombocytopenia; they occur because of the effect of chemotherapy on the rapidly dividing cells of the mucous membranes of the GI system. Diarrhea may be a side effect of chemotherapy, but it is not a thrombocytopenic side effect.
A hospitalized 3 yo child with leukemia is undergoing chemotherapy. The mother tells the nurse that her child is asking for fried chicken. How should the nurse respond? A. Fried foods might cause nausea and vomiting during chemotherapy B. Any food that is requested should be given because the child needs calories C. Coatings on foods to be fried may irritate the child's mouth and cause bleeding D. Foods from outside should not be brought to the unit because of the potential for infection
B. Because chemotherapy can cause nausea, vomiting, and anorexia, the child should be offered any food that is requested. Even if the nutritional quality is minimal, the child will be receiving needed calories. Fried foods can usually be eaten because generally they do not cause nausea and vomiting or irritate the mouth. Food prepared adequately should not be contaminated and therefore should not cause problems for a child undergoing chemotherapy.
The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. A. Monitor for signs of alopecia B. Encourage an increase in fluids C. Wash hands before entering the client's room D. Advise use of a soft toothbrush for oral hygiene E. Report an elevation in temperature immediately F. Encourage the client to eat raw, fresh fruits and vegetables
C, D, E. It is essential to prevent infection in a client with severe bone marrow depression; thorough handwashing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the HCP immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables and undercooked meat, eggs, and fish to prevent possible exposure to microbes.
A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply. A. Fever B. Diarrhea C. Headache D. Hematuria E. Ecchymosis
C, D, E. Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. This reduction of platelet activity impairs blood clotting, so any assessment finding associated with potentially abnormal bleeding would alert the nurse to the possibility of thrombocytopenia. This includes headache (bleeding into brain tissue), hematuria (bleeding within renal system), and ecchymosis (bleeding into skeletal soft tissue). Fever and diarrhea are common side effects of chemotherapy, but are not findings specifically attributed to thrombocytopenia.
A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. What explanation will the nurse provide? A. Steroid hormones have a depressant effect on the spleen and bone marrow B. Lymph node activity is depressed by radiation therapy used before chemotherapy C. Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs D. Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration
C. Chemotherapy destroys erythrocytes, WBCs, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are vulnerable to the effects of chemotherapy. Stating that steroid hormones have a depressant effect on the spleen and bone marrow is not a true description of the side effects of steroids. Depressed lymph node activity as a result of radiation therapy used before chemotherapy is not a cause for fewer RBCs, WBCs, and platelets. Although it is true that dehydration caused by NVD results in hemoconcentration, this does not explain pancytopenia.
