Lewis 15: Cancer Treatment and Care
d
A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Provide teaching about the importance of nutritional intake. d. Apply prescribed anesthetic gel to oral lesions before meals.
urine
A patient is being treated with radioactive iodine (131I) for thyroid cancer. For what major source of contamination from this patient should the nurse take precautions?
c
A patient is having whole brain radiation for brain metastasis and is concerned about how they will look when hair loss occurs. What is the best response by the nurse to this patient? a. "When your hair grows back, it will be patchy." b. "Don't use a curling iron and that will slow down the loss." c. "You can get a wig now to match your hair so you will not look different." d. "You should contact 'Look Good, Feel Better' to figure out what to do about this."
bce
A patient is treated with radiation therapy for lung cancer. The nurse observes that the patient has dry desquamation of the skin. How should the nurse prevent infection and facilitate healing of the skin? Select all that apply. a. Apply ice packs. b. Avoid constricting garments. c. Avoid the use of heating pads. d. Suggest the use of deodorants. e. Avoid rubbing the affected area.
bone marrow
A nurse discusses chemotherapy treatment with a patient with colon cancer. Which body system does the nurse tell the patient is most susceptible to the side effects of commonly used antineoplastic drugs?
b
A nurse is caring for a patient with cancer of the neck. While assessing the vital signs of the patient, the nurse notices bleeding in the cancerous area. Which nursing action is a priority? a. Start intravenous fluids. b. Apply pressure on the site. c. Inform the primary health care provider. d. Obtain a prescription for a blood transfusion.
bcde
A nurse is caring for a patient with lung cancer who is being treated with chemotherapy. The patient reports anorexia. How should the nurse ensure an adequate nutritional status of the patient? Select all that apply. a. Provide large meals. b. Weigh the patient regularly. c. Provide nutritional supplements. d. Provide high-calorie, high-protein food. e. Manage nausea and vomiting if present.
sarcoma
A nurse is collecting health history information from a patient who states, "I had cancer in the cartilage of my leg." What does the nurse recognize this type of malignancy in the connective tissue is called?
ace
A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)? a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work.
autologous
A/an ___ stem cell transplant requires harvesting the stem cells from the patient and transfusing it back to the patient after myeloablative therapy.
b
The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."
a
The laboratory report reveals that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? a. Cells are abnormal and moderately differentiated. b. Cells are very abnormal and poorly differentiated. c. Cells are immature, primitive, and undifferentiated. d. Cells differ slightly from normal cells and are well differentiated.
b
The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? a. Generalized muscle aches b. Crackles heard at the lung bases c. Complaints of nausea and anorexia d. Oral temperature of 100.6° F (38.1° C)
a
The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? a. Shortness of breath b. Shivering and chills c. Muscle aches and pains d. Temperature of 100.2° F (37.9° C)
a
During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Obtain more information about the family history. b. Schedule a sigmoidoscopy to provide baseline data. c. Teach the patient about the need for a colonoscopy at age 50. d. Teach the patient how to do home testing for fecal occult blood.
c
External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.
no
Following a surgery for colorectal cancer, the patient has persistent high carcinoembryonic antigen (CEA) levels. Based on this, was the tumor completely removed?
escape
Immunologic ___ is the cancer cells' evasion of immunologic surveillance, which allows the cancer cells to reproduce.
surveillance
Immunologic ___ is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors.
a
Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? a. A bland, low-fiber diet b. A high-protein, high-calorie diet c. A diet high in fresh fruits and vegetables d. A diet emphasizing whole and organic foods
b
The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.
metastasis
___ is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development.
myeloma
___ refers to cancer originating in blood-forming tissues such as bone marrow.
adenoma
___ refers to cancer originating in glandular tissue.
c
A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."
a
A patient who is undergoing external beam radiation therapy for cancer asks, "Will I be radioactive after the treatment?" What is an appropriate nursing response? a. The patient will not be radioactive at any time. b. Only the patient's urine and stool will be radioactive. c. The patient will be radioactive only during the treatment period. d. Although the patient's blood is radioactive, it will not affect anyone else.
c
A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure? a. Pain will be relieved by cutting sensory nerves in the stomach. b. Relief of pressure in the stomach will promote better nutrition. c. Decreasing the tumor size will improve the effects of other therapy. d. Tumor growth will be controlled by the removal of malignant tissue.
d
A patient with cancer is undergoing chemotherapy. The nurse suspects an IV infiltration of mechlorethamine hydrochloride. What action should the nurse take immediately? a. Stop the infusion and remove the IV line. b. Slow the infusion and monitor the site hourly. c. Continue the infusion and monitor the vital signs. d. Stop the infusion and leave the IV cannula in place.
b
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan? a. Donor bone marrow is transplanted through a sternal or hip incision. b. Hospitalization is required for several weeks after the stem cell transplant. c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. d. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.
c
A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken by the nurse, is appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient a glass of a citrus fruit beverage during treatments.
b
A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? a. "Don't you have any friends that will raise the children for you?" b. "Would you like to talk about options for the care of your children?" c. "For now you need to concentrate on getting well and not worrying about your children." d. "Many patients with cancer live for a long time, so there is time to plan for your children."
neutropenia
Chemotherapy may suppress the proliferation of bone marrow, resulting in ___, or low white blood cell counts.
a
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a. IL-2 enhances the body's immunologic response to tumor cells. b. IL-2 prevents bone marrow depression caused by chemotherapy. c. IL-2 protects normal cells from harmful effects of chemotherapy. d. IL-2 stimulates malignant cells in the resting phase to enter mitosis.
acde
The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine two or three times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening
angiogenesis
Tumor ___ is the process of blood vessels forming within the tumor itself.
surveillance
When caring for the patient with cancer, the response of the immune system to antigens of the malignant cells is immunologic ___.
d
Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration? a. Teach the patient to rest the brain by avoiding new activities. b. Teach that "chemo-brain" is a short-term effect of chemotherapy. c. Report patient symptoms immediately to the health care provider. d. Suggest use of a daily planner and encourage adequate rest and sleep.
tumor lysis
___ ___ syndrome is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can lead rapidly to acute renal injury. The hallmark signs are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.
thrombocytopenia
___ is a low platelet count that leaves the patient at high risk for life-threatening spontaneous hemorrhage.
b
he nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient has a history of dental caries. b. The patient swims several days each week. c. The patient snacks frequently during the day. d. The patient showers each day with mild soap.
d
A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he does not know what to say to his wife. Which nursing diagnosis is appropriate for the nurse to add to the plan of care? a. Compromised family coping related to disruption in lifestyle b. Impaired home maintenance related to perceived role changes c. Risk for caregiver role strain related to burdens of caregiving responsibilities d. Dysfunctional family processes related to effect of illness on family members
c
A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.
b
A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.
a
A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate? a. "The cancer involves only the cervix." b. "The cancer cells look like normal cells." c. "Further testing is needed to determine the spread of the cancer." d. "It is difficult to determine the original site of the cervical cancer."
b
A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care? a. Minimize activity until the treatment is completed. b. Establish time to take a short walk almost every day. c. Consult with a psychiatrist for treatment of depression. d. Arrange for delivery of a hospital bed to the patient's home.
b
The nurse is reviewing the medical record of a patient who has been newly diagnosed with testicular cancer. When considering the goal of curing cancer, the treatment is based on which of these principles? a. Surgery will be the single most effective treatment. b. Therapy will include a combination of treatment modalities. c. The risk for recurrent disease is lowest after treatment completion. d. Chemotherapy most often is tried as the initial treatment for most cancers.
d
The nurse is reviewing the role of the immune system in cancer development. Which of these statements explains the primary protective role of the immune system related to malignant cells? a. Immune cells bind with free antigen released by malignant cells. b. Immune cells produce blocking factors that immobilize cancer cells. c. The immune system produces antibodies that attack the cancer cells. d. The immune system provides surveillance for cells with tumor-associated antigens (TAAs).
b
The nurse caring for a patient undergoing chemotherapy finds that the patient has a low white blood cell (WBC) count. Which is an appropriate intervention? a. Monitor the respiratory rate of the patient. b. Administer white blood cell growth factors. c. Allow the patient to visit with family and friends. d. Request that the chemotherapy dose be reduced.
c
The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information? a. "How long ago were you diagnosed with this cancer?" b. "Do you have any concerns about body image changes?" c. "Can you tell me what has been helpful to you in the past when coping with stressful events?" d. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?"
hematuria
The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?
d
The nurse is caring for a patient who smokes two packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer? a. Teach the patient about the seven warning signs of cancer. b. Plan to monitor the patient's carcinoembryonic antigen (CEA) level. c. Teach the patient about annual chest x-rays for lung cancer screening. d. Discuss risks associated with cigarette smoking during each patient encounter.
c
The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? a. Hematocrit of 32% b. Pain with deep inspiration c. Serum sodium of 126 mEq/L d. Decreased breath sounds on left side
alopecia
The nurse is performing an assessment on a patient who is taking chemotherapy for breast cancer and observes loss of hair in small round areas on the scalp. How will the nurse document this assessment?
d
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider? a. Frequent loose stools b. Nausea and vomiting c. Elevated white blood count (WBC) d. Increased carcinoembryonic antigen (CEA)
d
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit 30% b. Platelets 95,000/μL c. Hemoglobin 10 g/L d. White blood cells (WBC) 2700/μL
c
The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will determine how much longer I have to live." c. "The biopsy will help decide the treatment for my enlarged prostate." d. "The biopsy will indicate whether the cancer has spread to other organs."
c
The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "I will need follow-up examinations for many years after treatment before I can be considered cured." d. "Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation."
d
The patient is being treated with brachytherapy for cervical cancer. What factors of protection must the nurse be aware of when caring for this patient? a. The medications the patient is taking b. The nutritional supplements that will help the patient c. How much time is needed to provide the patient's care d. The time the nurse spends with the patient and at what distance
b
The patient is receiving an intravenous (IV) vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? a. Ask the patient if the site hurts b. Turn off the chemotherapy infusion c. Call the prescribing health care provider d. Administer sterile saline to the reddened area
c
The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects (flu-like symptoms) of these medications? a. Ibuprofen b. Ondansetron c. Acetaminophen d. Morphine sulfate
