Chapter 20 Concepts of Care for Patients with Cancer

Which client statement allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment? "I may lose my hair during this treatment." "I will have a radioactive device in my body for a short time." "I must be positioned in the same way during each treatment." "I will be placed in a semiprivate room for company."

"I will have a radioactive device in my body for a short time." Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific. Because radiation therapy is site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation. The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.

The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body? Lung Veins of the legs Abdominal cavity Heart

Abdominal cavity Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity. Intravenous drugs are delivered through veins. Chemotherapy delivered into the lungs is typically placed in the pleural space (intrapleural). Chemotherapy is not typically delivered into the heart.

The nurse is caring for a client who is receiving rituximab for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect? Alopecia Fever Allergy Chills

Allergy Allergy is the most common side effect of monoclonal antibody therapy (rituximab), and the nurse must be aware of any allergic reactions the client may exhibit. Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being prescribed? Radioactive iodine-131 Allopurinol Recombinant erythropoietin Potassium chloride

Allopurinol The nurse expects allopurinol to be prescribed, because allopurinol decreases uric acid production and is indicated in TLS. TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances. Recombinant erythropoietin is used to increase red blood cell production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous because the client is already hyperkalemic. Radioactive iodine-131 is indicated in the treatment of thyroid cancer, not TLS.

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time? Explain that this occurs in some clients and is usually permanent. Inform the client that a small glass of wine may help her relax. Protect the client from infection. Allow the client an opportunity to express her feelings.

Allow the client an opportunity to express her feelings. Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client. Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.

When caring for the client receiving chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.) Select all that apply. Bruises Fever Epistaxis Pallor Petechiae

Bruises Epistaxis Petechiae Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count (thrombocytopenia).Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.

The RN working on an oncology unit has just received report on these clients. Which client will the nurse assess first? Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy. Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour. Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature.

Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature. The nurse should see the client with chemotherapy-induced neutropenia first. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people.The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.

Which instruction is appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy? Consume a diet high in fiber. Bathe in cold water. Wear cotton gloves when cooking. Make sure shoes are snug.

Consume a diet high in fiber. A high-fiber diet will assist with constipation related to neuropathy. The client should bathe in warm not cold water, not hotter than 96° F. Cotton gloves may prevent harm from scratching, but protective gloves should be worn for cooking, washing dishes, and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.

The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which intervention does the nurse plan to implement? (Select all that apply.) Select all that apply. Do not permit fresh flowers or plants in the room. Do not allow the client's 16-year-old son to visit. Observe for bleeding. Teach the client to omit raw fruits and vegetables from the diet. Administer pegfilgrastim. Assess for fever.

Do not permit fresh flowers or plants in the room. Teach the client to omit raw fruits and vegetables from the diet. Administer pegfilgrastim. Assess for fever. Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim and pegfilgrastim, is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms.Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.

When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? (Select all that apply.) Encourage the client to participate in changing the ostomy. Encourage the client and family members to express their feelings and concerns. Offer to have a person who is coping with a colostomy visit with the client. Explain to the client that the colostomy is only temporary. Obtain a psychiatric consultation.

Encourage the client to participate in changing the ostomy. Encourage the client and family members to express their feelings and concerns. Offer to have a person who is coping with a colostomy visit with the client. Encouraging the client to participate in changing the ostomy is an appropriate way for the client to become familiar with the ostomy and its care. A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication.Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment. Obtaining a psychiatric consultation may need to be done for clients with persistent depression, but would not be done immediately.

The nurse is teaching a client undergoing radiation therapy for laryngeal cancer. Which potential side effects will the nurse include? (Select all that apply.) Select all that apply. Fatigue Difficulty urinating Change in taste Difficulty swallowing Changes in hair color Changes in skin of the neck

Fatigue Change in taste Difficulty swallowing Changes in skin of the neck Radiation therapy to any site produces fatigue in most clients, and may cause clients to report changes in taste. Radiation side effects are site-specific. The larynx is in the neck, so changes in the skin of the neck may occur. Dysphagia (difficulty swallowing) may occur from radiation to the throat area.Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair, but this does not normally occur with radiation therapy. Difficulty urinating is not a side effect of radiation for laryngeal cancer.

The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression? Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% 5000 white blood cells/mm3 (5 × 109/L) 250,000 platelets/mm3 (250 × 109/L) Potassium level of 2.9 mEq/L (2.9 mmol/L) and diarrhea

Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% has anemia demonstrated by low hemoglobin and hematocrit levels. The client with diarrhea and a potassium level of 2.9 mEq/L (2.9 mmol/L) has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 (250 × 109/L), and the client with 5000 white blood cells/mm3 (5 × 109/L) demonstrate normal values.

When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication? Infection Drug toxicity Polycythemia Dose-limiting side effects

Infection The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase. Drug toxicity can develop when drug levels exceed peak concentrations. Polycythemia refers to an increase in the number of red blood cells; typically chemotherapy causes reduction of red blood cells or anemia. Dose limiting side effects occur when the dose or frequency of chemotherapy need to be altered or held, such as in the case of severe neutropenia or neurologic dysfunction.

The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia? Observe for motor deficits. Monitor weight. Monitor platelets. Trend red blood cells and hemoglobin and hematocrit.

Monitor weight. Cachexia results in extreme body wasting, malnutrition, and severe weight loss. Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting? Naloxone Ondansetron Diazepam Morphine

Ondansetron Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Lorazepam, a benzodiazepine, may also be given for nausea. Morphine is a narcotic analgesic or opiate and may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only.

Which client problem does the nurse determine as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? Potential for injury related to sensory and motor deficits Altered sexual function related to erectile dysfunction Potential for lack of understanding related to side effects of chemotherapy Potential for ineffective coping strategies related to loss of motor control

Potential for injury related to sensory and motor deficits The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client's safety because of the lack of sensation or innervation to the extremities. Every chemotherapy client needs to be taught related side effects of chemotherapy. The nurse should address the client's coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client's safety.

The nurse is teaching the client about skin protection during radiation therapy. What teaching will the nurse include? (Select all that apply.) Select all that apply. Protect the area by wearing clothing. Avoid all lotions to the area. Avoid exposure to sun and heat. Do not remove the ink markings on your skin. Try to take walks in the early morning or later evening. Do not wash the irradiated area.

Protect the area by wearing clothing. Avoid exposure to sun and heat. Do not remove the ink markings on your skin. Try to take walks in the early morning or later evening. The client can wash the irradiated area daily with either water or a mild soap. Ink or dye used to mark the radiation area should not be removed. The area should be protected by wearing soft clothing over the site, avoiding exposure to the sun and heat. Lotions can be used as long as they are approved by the radiation team. Walking in the early morning or late evening is a good way to avoid more intense sun.

When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful? Providing oral care with a disposable mouth swab Maintaining NPO until the lesions have resolved Encouraging oral care with commercial mouthwash Administering a biological response modifier

Providing oral care with a disposable mouth swab The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition and hydration are important during cancer treatment; a local anesthetic may be prescribed.

The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome will the nurse teach the client is the goal of palliative surgery? Prolonging the client's survival time Relief of symptoms or improved quality of life Allowing other therapies to be more effective Cure of the cancer

Relief of symptoms or improved quality of life The focus and goal of palliative surgery is to help relieve symptoms of end-stage cancer and improve quality of life during the survival time.

Which intervention will the oncology nurse use to prevent disseminated intravascular coagulation (DIC)? Monitoring platelets Using strict aseptic technique to prevent infection Administering packed red blood cells Administering low-dose heparin therapy for clients on bedrest

Using strict aseptic technique to prevent infection Sepsis is a major cause of DIC, especially in the oncology client. The oncology nurse must use strict asepsis to prevent any infection. Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.