Ch. 15 Oncology

After a bone marrow transplant (BMT), the client should be monitored for at least 30 days 14 days 100 days 60 days

100 days Explanation: After a BMT, the nurse closely monitors the client for at least 100 days or more after the procedure because complications related to the transplant can occur 100 days or more as post procedure infections are one common complication that may lead to sepsis and transplant failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Providing Care After Treatment, p. 351.

A nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching? 24 hours 2 to 4 days 7 to 14 days 21 to 28 days

7 to 14 days Explanation: Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018. 343

The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue? 95% 85% 75% 65%

95% Explanation: The radiation dosage is dependent on the sensitivity of the target tissues to radiation and on the tumor size. The lethal tumor dose is defined as the dose that will eradicate 95% of the tumor yet preserve normal tissue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Radiation Dosage, p. 339.

A client being treated for breast cancer reports pain as being 7 on a scale from 0 to 10. Which type of pain indicates to the nurse that the client is experiencing lymph obstruction from the disease? Sharp, throbbing Distention, crampy Dull, aching, tightness Burning, sharp, tingling

Dull, aching, tightness Explanation: Cancer can cause all types of pain. The pain associated with breast cancer due to lymphatic or venous obstruction can be described as dull, aching, and tight. Sharp, throbbing pain is caused by ischemia. Distention and cramping is associated with organ infiltration. Burning, sharp, and tingling pain is caused by nerve compression and infiltration.

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which of the following clinical findings in a client 2 weeks post therapy? Elevated temperature Ease of bruising Change in hair color Elevated white blood cells count

Ease of bruising

The client has a body surface area of 2.05 m². He is prescribed vincristine (Oncovin) 1.4 mg/m². Vincristine is available as 1 mg/1 mL. How many mL will the nurse administer? Round your answer to the nearest tenth.

2.9 Explanation: The dose ordered is 1.4 mg for each 1 m² of the client's body surface area, which is 2.05. 1.4 mg/m² x 2.05 m² = 2.87 mg. The dose available is 1 mg for each 1 mL. 1 mg/1 mL x 2.87 mg = 2.87 mL. Rounding your answer to 1 decimal place would be 2.9 mL. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Dosage, p. 342.

Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? Family history Drug history Blood studies Allergy history

Blood studies Explanation: Before the HSCT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before an HSCT procedure, the nurse need not evaluate client's family, drug, or allergy history.

Chemotherapeutic agents have which effect associated with the renal system? Hypokalemia Increased uric acid excretion Hypophosphatemia Hypercalcemia

Increased uric acid excretion Explanation: Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Urinary excretion of uric acid increases with the use of chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Renal System, p. 345.

The nurse is caring for a client newly diagnosed with cancer. Which of the following therapies is used to treat something other than cancer? A. Chemotherapy B. Radiation therapy C. Electroconvulsive therapy D. Surgery

C. Electroconvulsive therapy Cancer is frequently treated with a combination of therapies using standardized protocols. Three basic methods used to treat cancer are surgery, radiation therapy, and chemotherapy. Electroconvulsive therapy (ECT) is a method of treatment for mental distress or illness.

A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit? "I'll play card games with my friends." "I'll take a long trip to visit my aunt." "I'll bowl with my team after discharge." "I'll eat lunch in a restaurant every day."

"I'll play card games with my friends." Explanation: During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Managing Cognitive Changes, p. 348.

A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching? "I'll use hats to protect my head from the sun when my hair falls out." "If I get nauseous, I'll try to eat several small, bland meals each day." "I'll allow myself plenty of time to rest between activities." "Most of the adverse effects should go away shortly after my last radiation treatment."

"I'll use hats to protect my head from the sun when my hair falls out."

The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? "The hair loss is usually temporary." "New hair growth will return without any change to color or texture." "Clients with alopecia will have delay in grey hair." "Wigs can be used after the chemotherapy is completed."

"The hair loss is usually temporary." Explanation: Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-7: Plan of Nursing Care: The Patient With Cancer, p. 363.

29)Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy?

* fever

A client has been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions: (Select all that apply.) - Assess level of consciousness. - Apply pressure to the bleeding sites. - Assist the client to a chair. - Check intake and output records.

Assess level of consciousness. Apply pressure to the bleeding sites. Check intake and output records. The client may be experiencing disseminated intravascular coagulation (DIC) following the cancer experience and chemotherapy treatment. When the nurse notes the client is experiencing unexpected and abnormal bleeding, the nurse will assess level of consciousness (the client can be bleeding in the brain) and intake and output records (the client may experience decreased urinary output as a result of poor renal perfusion). The nurse applies pressure to venipuncture sites to decrease bleeding. The nurse will assess vital signs more frequently than once a shift. The nurse minimizes client activities to decrease risk for injury.

A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean? No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Can't assess tumor or regional lymph nodes and no evidence of metastasis Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Explanation: Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-3, p. 335.

The drug interleukin-2 is an example of which type of biologic response modifier? Cytokine Monoclonal antibodies Retinoids Antimetabolites

Cytokine Explanation: Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Cytokine, p. 354.

A patient with uterine cancer is being treated with intracavitary radiation. The patient will emit radiation while the implant is in place. The nurse is aware of the precautions necessary for the provider of care and visitors. Which of the following are appropriate guidelines to follow? Select all that apply. The nurse can provide direct care for up to 60 minutes per 8-hour shift. Family members should stand about 6 feet from the patient. Plastic aprons should be worn to buffer the exposure. Visitors may stay for 30 minutes or less.

Family members should stand about 6 feet from the patient. Visitors may stay for 30 minutes or less. Explanation: Exposure for the nurse, health care provider or visitors should be limited to 30 minutes/8-hour shift. As time increases, exposure to radiation increases. The goal is to deliver safe, efficient care in the shortest amount of time. Lead aprons can provide protection, not plastic aprons. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Protecting Caregivers, p. 341.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? Liver Colon Reproductive tract White blood cells (WBCs)

Liver Explanation: The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Surgery as Primary Treatment as Primary Treatment, p. 336.

The nurse is preparing to assess a client whose chart documents that the client experienced extravasation when receiving the vesicant vincristine during the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which conditions? Select all that apply. Sloughing tissue Tissue necrosis Active bleeding Effectiveness of the antidote

Sloughing tissue Tissue necrosis Effectiveness of the antidote Explanation: Extravasation of vesicant chemotherapeutic agents can lead to erythema, sloughing, and necrosis of surrounding tissue, muscle, and tendons. To reduce the likelihood and severity of symptoms due to extravasation of a vesicant, antidotes matched to the vesicant are administered. Nurses caring for a client who experienced extravasation of a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote.

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? Random, rapid growth of the tumor Cells colonizing to distant body parts Tumor pressure against normal tissues Emission of abnormal proteins

Tumor pressure against normal tissues Explanation: Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-1: Characteristics of Benign and Malignant Tumors, p. 326.

Which of the following would be consistent with a benign neoplasm? Usually progressive and slow Grows by invasion Gains access to the blood and lymph channels to metastasize Cells are undifferentiated

Usually progressive and slow Explanation: A benign neoplasm's rate of growth is usually progressive and slow. Malignant neoplasms have undifferentiated cells, grow by invasion, and gain access to the blood and lymph channels to metastasize to other areas of the body. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-1, p. 326.

What is the best way for the nurse to assess the nutritional status of a patient with cancer? Weigh the patient daily. Monitor daily caloric intake. Observe for proper wound healing. Assess BUN and creatinine levels.

Weigh the patient daily. Explanation: Common nutritional problems in clients with cancer include anorexia, malabsorption, and the extreme weight loss of cancer-related anorexia-cachexia syndrome (CACS). Because malnutrition may occur due to problems with absorption of nutrients or increased metabolic demands, weighing the client regularly is the best way to monitor nutritional status. The client's caloric intake should also be monitored, keeping in mind that nutritional status may suffer even if caloric intake may seem sufficient. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Nutritional Impairment, p. 371.

Which of the following would be inconsistent as a common side effect of chemotherapy? Weight gain Alopecia Myelosuppression Fatigue

Weight gain Explanation: Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Toxicity, pp. 344-347.

A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.) inspects for skin damage of the chest area assesses the client for any sun exposure uses cool water to wash the neck area applies an over-the-counter ointment to the skin avoids shaving the irradiated skin

assesses the client for any sun exposure avoids shaving the irradiated skin Explanation: The client receiving external beam radiation therapy may experience trauma to the irradiated skin. To prevent further skin damage, the client is to avoid sun exposure and shaving the irradiated skin area. Other skin areas are not damaged, only the irradiated skin. Lukewarm water is to be used to bathe the area. Water of extreme temperature should be avoided. Many over-the-counter ointments contain metals and may cause additional skin damage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-7, p. 359.

The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as brachytherapy. external beam radiation therapy. systemic radiation. a contact mold.

brachytherapy. Explanation: Brachytherapy is the only term used to denote the use of internal radiation implants.

Carcinogens are factors related to the formation of various malignancies. Which factor has the greatest impact on the development of all cancers? chemical agents environmental factors viruses defective genes

chemical agents Explanation: Chemical agents in the environment are believed to account for 75% of all cancers. Environmental factors include prolonged exposures to sunlight, radiation, and pollutants. Although such factors have been linked to cancer, they are not considered its leading cause. Viruses and bacteria are implicated in many cancers, however they do not have the greatest impact on the development of all cancers. It is known that genes play a major role in cancer prevention or development. Defective genes are responsible for diverse cancers, however they do not have the greatest impact on the development of all cancers. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 15: Management of Patients with Oncologic Disorders, p. 329.

The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply. dietary substances environmental factors viruses chemical agents defective genes hormone replacement therapy

dietary substances environmental factors viruses chemical agents defective genes hormone replacement therapy Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Etiology, p. 327.

A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through: inhalation of aerosols. absorption through the gown. absorption through the gloves. absorption through the goggles.

inhalation of aerosols. Explanation: Aerosol inhalation or absorption through the skin can cause accidental chemotherapy exposure. A nurse must wear a disposable gown and gloves when preparing and administering chemotherapy. She won't absorb chemicals through an intact gown, protective gloves, or goggles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-5, p. 349.

A client reports dyspnea, fatigue, and having had a persistent productive cough for the last few months, which the client attributes to a bout with the flu. The nurse suspects that this client may have: lung cancer. lung abscess. pleural effusion. pleurisy.

lung cancer.

A client with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. What mechanism of action do antimetabolites interferes with? cell division or mitosis during the M phase of the cell cycle normal cellular processes during the S phase of the cell cycle the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific) one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle-nonspecific)

normal cellular processes during the S phase of the cell cycle Explanation: Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Antimetabolites, p. 343.

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching? cryoablation prophylactic local excision palliative

prophylactic Explanation: Also called preventive surgery, prophylactic surgery may be done when there is a family history or genetic predisposition, ability to detect cancer at an early stage, and client acceptance of the postoperative outcome. Local excision is done when an existing tumor is removed along with a small margin of healthy tissue. Palliative surgery relieves symptoms. Cryoablation uses cold to destroy cancerous cells. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 15: Management of Patients with Oncologic Disorders, p. 337.

A client who underwent thoracic surgery to remove a lung tumor had a chest tube placed anteriorly. The surgical team places this catheter to: remove fluid from the lungs. remove air from the pleural space. administer IV medication. ventilate the client.

remove air from the pleural space.

A client with a recent history of GI disturbance has been scheduled for a barium study. The physician ordered this particular test for this client because it will: show movement of the GI tract. remove a tissue sample from the GI tract. show tumor "hot spots" in the GI tract. provide a three-dimensional cross-sectional view.

show movement of the GI tract. Explanation: A barium study is an example of fluoroscopy, which is used to show continuous x-ray images on a monitor, allowing the movement of a body structure to be viewed. Fluoroscopy does not involve the biopsy of tissue samples. Nuclear imaging, not a barium study, uses IV tracers to reveal tumor hot spots. CT scans provide three-dimensional cross-sectional views of tissues to determine tumor density, shape, size, volume, and location as well as highlighting blood vessels that feed the tumor. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 15: Management of Patients with Oncologic Disorders, p. 334.

The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? "I hope they find a bone marrow donor who matches." "The doctor will remove cells from my bone marrow before beginning chemotherapy." "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." "I will need to attend follow-up visits for up to 3 months after treatment."

"I hope they find a bone marrow donor who matches." Explanation: An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months, but not in protective isolation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Types of Hematopoietic Stem Cell Transplantation, p. 349.

The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective? "I will brush my teeth after every meal." "I will reduce smoking to after meals only." "I will eat spicy foods with a cool beverage." "I will limit alcoholic beverages to one a day."

"I will brush my teeth after every meal." Explanation: Stomatitis is an inflammatory process of the mouth, including the mucosa and tissues surrounding the teeth. Manifestations of stomatitis include changes in sensation, erythema, and edema, or if severe, painful ulcerations, bleeding, and infection. It commonly develops within 3 to 14 days after receiving certain chemotherapeutic agents. Actions to prevent the development of stomatitis include brushing the teeth with a soft toothbrush for 90 seconds after every meal. Smoking dries oral tissues and should be avoided. Spicy foods can irritate the oral tissues and should be avoided. Alcohol is drying to the oral tissues and should be avoided.

The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a positive biopsy? A lump excision is not necessary. A wide excision of lump will be performed. The lump and all axillary lymph nodes will be excised. The entire breast and all regional lymph nodes will be excised.

A wide excision of lump will be performed. Explanation: The sentinel node is the first node in which a tumor will drain; if no malignant cells are found there, additional excision or radical removal will not be necessary. Excision of the lump along with a wide margin of cancer-free tissue is standard treatment for malignant tumors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Surgery as Primary Treatment, p. 336.

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? Antimetabolite Alkylating Nitrosoureas Mitotic spindle poisons

Antimetabolite Explanation: 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-7 Select Antineoplastic Agents, p. 343.

A client with cancer is receiving chemotherapy and reports to the nurse that his mouth is painful and he has difficulty ingesting food. The nurse does which of the following: Rinses the client's mouth with alcohol-based mouthwash every 2 hours Teaches the client to floss his teeth once every 24 hours Asks the client to open his mouth to facilitate inspection of the oral mucosa Consults with the healthcare provider about use of nystatin (Mycostatin) Instructs the client to brush the teeth with a soft toothbrush

Asks the client to open his mouth to facilitate inspection of the oral mucosa Consults with the healthcare provider about use of nystatin (Mycostatin) Instructs the client to brush the teeth with a soft toothbrush

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? Encourage fluid intake to dilute the urine. Take measures to acidify the urine and prevent uric acid crystallization. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

Encourage fluid intake to dilute the urine. Explanation: The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Renal System, p. 345.

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue? Excisional biopsy Incisional biopsy Needle biopsy Punch biopsy

Excisional biopsy Explanation: Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Biopsy Types, p. 335.

You are the nurse caring for a client with cancer. The client complains of pain and nausea. When assessed, you note that the client appears fearful. What other factor must you consider when a client with cancer indicates signs of pain, nausea, and fear? Infection Fatigue Ulceration High cholesterol levels

Fatigue Explanation: Clients with cancer experience fatigue, which is a side effect of cancer treatments that rest fails to relieve. The nurse must assess the client for other stressors that contribute to fatigue such as pain, nausea, fear, and lack of adequate support. The nurse works with other healthcare team members to treat the client's fatigue. The above indications do not contribute to infections, ulcerations, or high cholesterol levels. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Fatigue, p. 347.

The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? Use disposable utensils for the next month. Flush the toilet twice after every use. Prepare food separately from family members. Shield your throat area when near others.

Flush the toilet twice after every use.

Which grade of tumor is also known as a well-differentiated tumor? Grade I Grade II Grade III Grade IV

Grade I Explanation: Grade I tumors, also known as well-differentiated tumors, closely resemble the tissue of origin in structure and function. In grade II, the tumor is moderately differentiated. Tumors in grade III are poorly differentiated (little resemblance to tissue of origin). Grade IV tumors is undifferentiated (unable to tell tissue of origin). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Tumor Staging and Grading, p. 333.

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? Normal finding Benign fibrocystic disease Malignant tumor Malignant tumor with metastasis to surrounding tissue

Malignant tumor Explanation: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.

You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer? Palliative surgery Prophylactic surgery Curative surgery Reduction surgery

Prophylactic surgery Explanation: Prophylactic or preventive surgery may be done if the client is at considerable risk for cancer. Palliative surgery is done when no curative treatment is available. Curative surgery is performed to cure the disease process. Reduction surgery is a distractor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Prophylactic surgery, p. 337.

Nursing action for extravasation of a chemotherapeutic agent would include which of the following nursing actions? Select all that apply. Stop the medication infusion at the first sign of extravasation. Administer an antidote, if indicated. Aspirate any residual drug from the IV line. Apply warm compresses to the irritated site to encourage healing.

Stop the medication infusion at the first sign of extravasation. Administer an antidote, if indicated. Aspirate any residual drug from the IV line.

Which statement is true about malignant tumors? They demonstrate cells that are well differentiated. They gain access to the blood and lymphatic channels. They usually grow slowly. They grow by expansion.

They gain access to the blood and lymphatic channels. Explanation: By gaining access to blood and lymphatic channels, a tumor can metastasize to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rates of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Table 15-1.

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line With a butterfly needle With a soft, plastic catheter In the client's right forearm In the client's left hand

With a soft, plastic catheter

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful? "I clean my teeth gently several times per day." "I replace my toothbrush every month." "I lubricate my lips with petroleum jelly." "I use an alcohol-based mouthwash every morning."

"I clean my teeth gently several times per day." Explanation: The client demonstrates understanding when he states that he'll clean his teeth gently several times per day. Frequent gentle cleaning of the mouth or rinsing reduces bacteria build-up in the oral cavity, thus reducing the risk for oropharyngeal infection. Changing the toothbrush each month reduces the bacteria in the mouth for the first few uses only. Petroleum jelly moistens the lips, but doesn't prevent breakdown of the mucous membranes or reduce the risk for oropharyngeal infection. Alcohol-based products cause drying of the mucous membrane, increasing the likelihood of oropharyngeal infection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-7, p. 360.

A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse? "It allows time for you to cope with the treatment." "It will allow time for the repair of healthy tissue." "It will decrease the incidence of leukopenia and thrombocytopenia." "It is not really understood why you have to go for 6 weeks of treatment."

"It will allow time for the repair of healthy tissue." Explanation: In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Toxicity, p. 340.

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? Autologous Prophylactic Therapeutic Allogeneic

Autologous Explanation: Autologous vaccines are made from the client's own cancer cells, which are obtained during diagnostic biopsy or surgery. Prophylactic vaccines, such as the polio vaccine, are given to prevent people from developing a disease. Therapeutic vaccines are given to kill existing cancer cells and to provide long-lasting immunity against further cancer development. Allogeneic vaccines are made from cancer cells that are obtained from other people who have a specific type of cancer.

A client diagnosed with cancer has the tumor staged and graded based on what? How the tumor tends to grow and the cell type How the tumor spreads and tends to grow How the tumor differentiates the cell type How the tumor spreads and differentiates

How the tumor tends to grow and the cell type Explanation: Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Tumor Staging and Grading, p. 333.

An oncology nurse is caring for a client who is taking antineoplastic agents. What symptoms would the nurse consider with tumor lysis syndrome when monitoring this client? symptoms of gout symptoms of hypertension symptoms of constipation symptoms of anemia

symptoms of gout Explanation: The nurse monitors the client being administered an antineoplastic agent for symptoms of gout, which include increased uric acid levels, joint pain, and edema, with the consideration of tumor lysis syndrome. Administering antineoplastic agents does not cause hypertension, constipation, or anemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-13, p. 383.

A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery? "Removing the tumor is a primary treatment for colon cancer." "This surgery will prevent further tumor growth." "Once the tumor is removed, cell pathology can be determined." "Tumor removal will promote comfort."

"Tumor removal will promote comfort." Explanation: Palliative surgeries, such as bowel resection, may be performed to promote comfort by relieving pain and pressure on organs within the abdominal cavity. Primary treatment refers to surgery that is likely to provide a cure, which is not likely in metastatic disease. With metastasis, primary tumor removal does not prevent further tumor growth in distant sites. The diagnosis of colon cancer with metastasis suggests cell pathology has already been determined. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Surgery as Primary Treatment, p. 336.

During a client's examination and consultation, the physician keeps telling the client, "You have an abdominal neoplasm." Which statements accurately paraphrase the physician's statement? Select all that apply. "You have a new growth of abnormal tissue in your abdomen." "You have an abdominal tumor." "You have an abdominal malignancy." "You have abdominal cancer."

"You have a new growth of abnormal tissue in your abdomen." "You have an abdominal tumor." Explanation: New growths of abnormal tissue are called "tumors." Tumors may be benign or malignant; not all tumors are cancerous. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 15: Management of Patients with Oncologic Disorders, p. 327.

Which oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)? A. Syndrome of inappropriate antidiuretic hormone release (SIADH) B. Tumor lysis syndrome C. Cardiac tamponade D. Disseminated intravascular coagulation (DIC)

A. Syndrome of inappropriate antidiuretic hormone release (SIADH)-SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis, which results in thrombosis and bleeding. Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

A patient diagnosed with colon cancer presents with the characteristic symptoms of a left-sided lesion. Which of the following symptoms are indicative of this disorder? Select all that apply. Abdominal distention Black, tarry stools Constipation Narrowing stools Dull abdominal pain

Abdominal distention Constipation Narrowing stools

The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action? Taking the client's temperature rectally Providing commercial mouthwash to the client Providing a razor so the client can shave Avoiding the use of products containing aspirin

Avoiding the use of products containing aspirin Explanation: Clients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding the use of products such as aspirin that may interfere with the client's clotting systems; avoiding taking temperature rectally and administering suppositories; providing the client with an electric shaver for shaving; and avoiding commercial mouthwashes because of their potential to dry out oral mucosa, which can lead to cracking and bleeding. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chart 15-7.

A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? Avoiding using soap on the irradiated areas Applying talcum powder to the irradiated areas daily after bathing Wearing a lead apron during direct contact with the client Removing thoracic skin markings after each radiation treatment

Avoiding using soap on the irradiated areas Explanation: Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-7, p. 359.

Following a BMT the patient should be monitored for at least A. 3 days. B. 3 months. C. 5 months. D. 4 weeks.

B. 3 months.After a BMT, the nurse closely monitors the patient for at least 3 months because complications related to the transplant are still possible, and infections are very common.

The nurse should teach the patient who is being radiated about protecting his skin and oral mucosa. An important teaching point would be to tell the patient to: Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. Use an ointment, after treatment, to decrease the feeling of burning, which may last for several hours. Apply a small ice compress to the treated area afterward to decrease localized redness, post-radiation. Use an approved emollient 2 hours before the radiation to give the skin time to absorb the medication and provide a shield for damage.

Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. Explanation: The patient should cleanse himself with a mild soap using his fingertips rather than a wash cloth. All the other choices will irritate the skin and fail to protect it from additional injury. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-7, p. 359.

The nurse is preparing a teaching tool about alopecia caused by cancer treatment. Which information will the nurse emphasize in this tool? Select all that apply. Use a hair dryer to quickly dry the hair. Cut long hair before treatment begins. Use shampoo and conditioner every day. Use a wide-tooth comb to style the hair. Avoid hair dyes or permanent wave solutions.

Cut long hair before treatment begins. Use a wide-tooth comb to style the hair. Avoid hair dyes or permanent wave solutions. Explanation: Hair loss can begin shortly after starting chemotherapy or radiation therapy as treatment for cancer. The teaching tool should include information that helps minimize hair loss to include cutting long hair before treatment begins as this will reduce the weight and manipulation of the hair. A wide-toothed comb protects the scalp and prevents accidental loss of hair through routine maintenance. Hair dyes and permanent solutions should be avoided as this will protect the scalp and prevent accidental hair loss and scalp irritation. Hair dryers should be avoided as this will protect the scalp from accidental injury. Daily use of shampoos and conditioners should be avoided as this will encourage hair loss and lead to potential scalp injury. Conditioners are unnecessary.

A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment? A. For skin cancer B. For cancer of the lungs C. For cancer of the breast D. For cancer of the bladder

D. For cancer of the bladder -Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer (Polovich et al, 2009).

The nurse is teaching a healthy lifestyle class to a group of adolescents. The nurse recommends Eating four servings of vegetables and fruits per each day Decreasing caloric intake to maintain a body mass index lower than 24 Exercising at least 60 minutes per day doing moderate to vigorous activities at least 5 days per week Increasing proteins to more than 5 1/2 ounces per day for the male students to build muscle mass

Exercising at least 60 minutes per day doing moderate to vigorous activities at least 5 days per week Explanation: The American Cancer Society recommendations are for adolescents to engage in at least 60 minutes of moderate to vigorous physical activity at least 5 days per week. The MyPyramid recommendations include 4 1/2 cups of fruits and vegetables every day. People who have a body mass index less than 24 are at increased risk for problems associated with poor nutritional status. Ingesting more protein will not necessarily build more muscle mass and is not recommended for normal healthy individuals. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Life Style Factors, p. 330.

A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer? Persistent nausea Rash Indigestion Chronic ache or pain

Indigestion Explanation: Indigestion is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn't one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Diagnosis of Cancer, p. 333.

A client has received several treatments of bleomycin. It is now important for the nurse to assess Skin integrity Lung sounds Urine output Hand grasp

Lung sounds Explanation: Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Cardiopulmonary System, p. 346.

According to the tumor-node-metastasis (TNM) classification system, T0 means there is No evidence of primary tumor No regional lymph node metastasis No distant metastasis Distant metastasis

No evidence of primary tumor Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis. Chart 15-3

The nursing instructor is talking with the junior class of nursing students about lung cancer. What would be the best rationale the instructor could give for the difficulty of early diagnosis of lung cancer? Symptoms are often minimized by clients. There are no early symptoms of lung cancer. Symptoms often mimic other infectious diseases. Symptoms often do not appear until the disease is well established.

Symptoms often mimic other infectious diseases.

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line In the client's left hand With a butterfly needle In the client's right forearm With a soft, plastic catheter

With a soft, plastic catheter Explanation: Vesicant chemotherapy should never be administered in the peripheral veins involving the hand or wrist. A person with breast cancer is to avoid injections in the affected extremity. A soft, plastic catheter should be used, not a butterfly needle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Extravasation, p. 342.

30)During a routine physical examination, a client confides that he is terrified of developing prostate cancer like his father. What are the warning signs of prostate cancer? Select all that apply.

weak and interrupted urine flow continuous pain in the lower back *pain in the upper thighs

The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response? "Benign tumors don't usually cause death." "Benign tumors grow very rapidly." "Benign tumors can spread from one place to another." "Benign tumors invade surrounding tissue."

"Benign tumors don't usually cause death." Explanation: Benign tumors remain at their site of development. They may grow large, but their growth rate is slower than that of malignant tumors. They usually do not cause death unless their location impairs the function of a vital organ, such as the brain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Molecular Process, p. 326.

A nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal Pap test results for the past 10 years. The client asks about continuing the Pap test. What is the best response by the nurse? "You will need to continue for the rest of your life." You need to continue obtaining a Pap test for only the next 5 years." "You could have stopped immediately after your hysterectomy." "You may choose to discontinue this test."

"You may choose to discontinue this test." Explanation: The American Cancer Society recommendations for women 66+ years or older who have had normal Pap tests for 10 years and who have had a total hysterectomy may choose to stop having Pap tests for cervical cancer screening. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-3, p. 332.

31)Which patient instructions are necessary for a client receiving systemic internal radiation therapy who is being discharged? Select all that apply.

*Wash hands carefully following toileting.

When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply. Hypercalcemia Hyperkalemia Hyperuricemia Hyperphosphatemia

Hyperkalemia Hyperuricemia Hyperphosphatemia Explanation: When intracellular contents are released into the bloodstream, phosphorous is elevated. This results in an inverse decline in the levels of calcium, so hypercalcemia would not occur. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-13, p. 383.

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? It is used to remove cancerous cells using a needle. It removes an entire lesion and the surrounding tissue. It removes a wedge of tissue for diagnosis. It treats cancer with lymph node involvement.

It removes a wedge of tissue for diagnosis. Explanation: The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: The three drugs can be given at lower doses. The second and third drugs increase the effectiveness of the first drug. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.

The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Explanation: Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Management of Cancer, p. 334.

A nurse is caring for a client newly diagnosed with cancer. Which therapies are used to treat cancer? Select all that apply. surgery hyperthermia radiation therapy chemotherapy electroconvulsive therapy

surgery hyperthermia radiation therapy chemotherapy Explanation: Cancer is frequently treated with a combination of therapies using standardized protocols. The basic methods used to treat cancer are surgery, radiation therapy, hyperthermia, and chemotherapy. Electroconvulsive therapy is a method of treatment for mental distress or illness. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, p. 334.

A nurse is caring for a recently married, 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment? "I should be able to finally start a family after I'm finished with the chemo." "I always had a good appetite. Even with chemo I shouldn't have to make any changes to my diet." "I'll have to remain in the hospital for about 3 months after my transplant." "I'll only need chemotherapy treatment before receiving my bone marrow transplant."

"I'll only need chemotherapy treatment before receiving my bone marrow transplant." Explanation: This client demonstrates understanding about treatment when she states that she'll need chemotherapy before receiving a bone marrow transplant. Most clients receive chemotherapy before undergoing bone marrow transplantation. Most women older than age 26 can't bear children after undergoing treatment because they experience the early onset of menopause. Clients who undergo chemotherapy or radiation must avoid all fresh fruits and vegetables, and all foods should be cooked to avoid bacterial contamination. Clients who undergo bone marrow transplantation typically remain hospitalized for 20 to 25 days. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Implementing Care Before Treatment, p. 350.

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? A. "I floss my teeth every morning." B. "I use an electric razor to shave." C. "I removed all the throw rugs from the house." D. "I take a stool softener every morning."

A. "I floss my teeth every morning."A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.

A client is undergoing chemotherapy treatment for prostate cancer and has lost considerable weight due to nausea and vomiting. Which nursing intervention is appropriate for the client? Decreasing dietary fluids 2 days before chemotherapy Adjusting the client's meal plan before and after chemotherapy Increasing fresh fruits in the client's diet Administering beta-blockers as ordered by the physician

Adjusting the client's meal plan before and after chemotherapy Explanation: The nurse should readjust the client's meal plan before and after chemotherapy administration. The nurse should take into consideration the client's likes and dislikes and avoid foods with strong odors. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the client has side effects of nausea and vomiting. Fresh fruits are not recommended when the client is at risk of infection, such as during chemotherapy. Beta-blockers are not administered to control nausea and vomiting. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chart 15-7.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? No further treatment is indicated. Adjuvant therapy is likely. Palliative care is likely. Repeat biopsy is needed before treatment begins.

Adjuvant therapy is likely. Explanation: T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-3: TNM Classification System, p. 335, 341, 381.

A 67-year-old client is admitted for diagnostic studies to rule out cancer. The patient is white, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? Select all that apply. Age Cigarette smoking Occupation Race Marital status

Age Cigarette smoking Occupation Explanation: Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in Black men remain substantially higher than those among White men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans (Fontham et al., 2009). Smoking is strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia. Marital status is not associated with risk for cancer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Life Style Factors, p. 329.

The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient? Impaired nutritional status Cognitive changes Alopecia Diarrhea

Impaired nutritional status

A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to: Report the unusual sign of nausea. Be alarmed if she notices fluid retention. Increase her intake of calcium-rich foods. Report the unexpected sign of increased appetite and weight gain.

Increase her intake of calcium-rich foods. Explanation: One of the major side effects of Aromasin is hypocalcemia and the subsequent loss of bone. Therefore, the patient needs to have periodic blood work done, have bone density tests done, and follow a diet that will supply needed calcium that is being pulled from the bone tissue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-13, p. 382.

When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? Time, distance, and shielding The use of disposable utensils and wash cloths Avoid showering or washing over skin markings. Inspect the skin frequently.

Inspect the skin frequently. Explanation: Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Toxicity, p. 340.

The nurse is caring for a client with cancer who is treating her cancer with deep-tissue massage in addition to radiation therapy. The nurse documents the use of which therapy on the client's chart? Alternative therapy Global medicine Integrative medicine Compliant medicine

Integrative medicine Explanation: Integrative medicine is the use of therapies in conjunction with conventional medicine. This is also known as complementary medicine. Alternative therapies are used instead of conventional medicine.

A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician orders mitomycin and other chemotherapeutic agents for palliative treatment. How does mitomycin exert its cytotoxic effects? It inhibits deoxyribonucleic acid (DNA) synthesis. It inhibits ribonucleic acid (RNA) synthesis. It's cell cycle-phase specific. It inhibits protein synthesis.

It inhibits deoxyribonucleic acid (DNA) synthesis. Explanation: Mitomycin (Mutamycin) exerts its cytotoxic effects by inhibiting DNA synthesis rather than RNA synthesis. It's cell cycle-phase nonspecific and doesn't inhibit protein synthesis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-7, p. 343.

A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? It interferes with deoxyribonucleic acid (DNA) replication only. It interferes with ribonucleic acid (RNA) transcription only. It interferes with DNA replication and RNA transcription. It destroys the cell membrane, causing lysis.

It interferes with DNA replication and RNA transcription. Explanation: Thiotepa interferes with DNA replication and RNA transcription. It doesn't destroy the cell membrane. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Table 15-7, p. 343.

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the bestteaching by the nurse? It stimulates the immune system against the tumor cells. It treats drug-related anemia. It prevents alopecia. It lowers serum and uric acid levels.

It lowers serum and uric acid levels. Explanation: The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurrence can be reduced with allopurinol's action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure. Allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Renal System, p. 345, 383.

A client receiving treatment for a terminal illness develops cancer-related anorexia-cachexia syndrome (CACS). Which interventions will the nurse add to this client's plan of care? Select all that apply. Limit the intake of fluids during meals. Encourage the client to eat three meals per day. Remind the client to avoid alcoholic beverages at mealtimes. Remove unpleasant sights and odors before meals. Suggest foods that are high in calories and protein.

Limit the intake of fluids during meals. Remove unpleasant sights and odors before meals. Suggest foods that are high in calories and protein. Explanation: CACS is a complex biologic process that results from a combination of increased energy expenditure and decreased intake. Combined immunologic, neuroendocrine, and metabolic processes give rise to anorexia, unintentional weight loss, and increased metabolic demand with impaired metabolism of glucose and lipids. As this syndrome continues, altered metabolic processes and tumor responses lead to cytokine release, causing generalized systemic inflammation. The client experiences continued weight loss and malnutrition characterized by loss of adipose tissue, visceral protein, and skeletal muscle mass. Clients with CACS report loss of appetite, early satiety, and fatigue. Interventions to help with CACS include limiting fluids during meals because they can contribute to early satiety. Unpleasant sights and odors should be removed before meals since anorexia can increase with noxious stimuli. Foods that are high in calories and protein should be suggested as these foods help maintain nutritional status during periods of increased metabolic demand. Smaller and more frequent meals should be encouraged as they are better tolerated and reduce early satiety. Alcoholic beverages should be encouraged as they will stimulate the appetite and add calories.

A patient is taking vincristine, a plant alkaloid for the treatment of cancer. What system should the nurse be sure to assess for symptoms of toxicity? Gastrointestinal system Nervous system Pulmonary system Urinary system

Nervous system Explanation: With repeated doses, the taxanes and plant alkaloids, especially vincristine, can cause cumulative peripheral nervous system damage with sensory alterations in the feet and hands. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Neurologic System, p. 346.

The nurse at the clinic explains to the patient that the surgeon will be removing a mole on the patient's back that has the potential to develop into cancer. The nurse informs the patient that this is what type of procedure? Diagnostic Palliative Prophylactic Reconstructive

Prophylactic Explanation: Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk of developing cancer. When surgical cure is not possible, the goals of surgical interventions are to relieve symptoms, make the patient as comfortable as possible, and promote quality of life as defined by the patient and family. Palliative surgery and other interventions are performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusions (Table 15-6). Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Diagnostic surgery, or biopsy, is performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Prophylactic Surgery, p. 337.

A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis? Recommend that the client discontinue chemotherapy. Provide a solution of viscous lidocaine for use as a mouth rinse. Monitor the client's platelet and leukocyte counts. Check regularly for signs and symptoms of stomatitis.

Provide a solution of viscous lidocaine for use as a mouth rinse. Explanation: To decrease the pain of stomatitis, the nurse should provide a solution of viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection, but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Stomatitis, p. 357.

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? Clarify information provided by the physician. Provide aseptic care to the incision postoperatively. Provide time for the patient to discuss her concerns. Counsel the patient about the possibility of losing her breast.

Provide time for the patient to discuss her concerns. Explanation: Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery. The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse's response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Nursing Management, p. 337.

A client reports a new onset of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. The health care provider orders a diagnostic workup, which reveals end-stage gallbladder cancer. What nursing intervention should be used to facilitate adaptive coping? Refer client for professional counseling. Encourage ventilation of negative feelings. Assist with self-care activities of daily living. Provide written education for prescribed treatments.

Refer client for professional counseling. Explanation: Referring the client for professional counseling will facilitate adaptive coping. Encouraging ventilation of negative feelings will allow for emotional expression, but may not facilitate coping. Physical well-being will increase self-esteem, but won't necessarily help the patient cope with the diagnosis. Providing written education is for client teaching, not to facilitate coping. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-7, p. 368.

A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis? Risk for infection related to inadequate defenses Fatigue related to deficient blood cells Activity intolerance related to side effects of chemotherapy Anxiety related to change in role function

Risk for infection related to inadequate defenses Explanation: Physiological needs, such as risk for infection, take priority over the client's other needs. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Monitoring and Managing Potential Complications, p. 376.

A nurse is administering a peripheral chemotherapeutic agent. What nursing actions are used for extravasation of a chemotherapeutic agent? Select all that apply. Stop the medication infusion at the first sign of extravasation Aspirate any residual drug from the IV line Administer an antidote, if indicated Apply warm compresses to the irritated site to encourage healing Schedule the client for implanted device

Stop the medication infusion at the first sign of extravasation Aspirate any residual drug from the IV line Administer an antidote, if indicated Explanation: All of the answers except application of a warm compress are appropriate nursing actions. The application of warmth would be contraindicated because it would cause vasodilation, which would increase the absorption of irritant into the local tissues. Short term chemotherapy can be done with peripheral catheters so the client may not need an implanted device. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Extravasation, p. 342.

A client asks the nurse what is causing the fatigue following radiotherapy. What is the nurse's best response? The cancer is spreading to other parts of the body. The cancer cells are dying in large numbers. Fighting off infection is an exhausting venture. Substances are released when tumor cells are destroyed.

Substances are released when tumor cells are destroyed. Explanation: Fatigue results from substances being released when tumor cells are destroyed during radiotherapy. The spreading of cancer can cause many symptoms dependent on location and type of cancer, but it is not a significant factor in the development of fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support the presence of infection in this client. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 15: Management of Patients with Oncologic Disorders, Internal Radiation, p. 339.