PrepU Chapter 15: Management of Patients with Oncologic Disorders
Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? Family history Blood studies Allergy history Drug history
Blood studies 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.
The health care provider recommends that parents have their daughter vaccinated with HPV vaccine. What is this vaccine for? Help prevent lung cancer Help prevent cervical cancer Help prevent breast cancer Help prevent leukemia
Help prevent cervical cancer Explanation: The vaccines that are approved for use in the United States include the human papilloma virus (HPV), which may help prevent women from getting cervical, head, and neck cancers. There are no vaccines for the prevention of lung cancer, breast cancer, or leukemia.
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 treats cancer with lymph node involvement. It removes a wedge of tissue for diagnosis. 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. 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.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Promotion Prolongation Progression Initiation
Progression Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.
A client with metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy? Chapter 15: Management of Patients with Oncologic Disorders.
To prevent metastasis Chemotherapy treats systemic and metastatic cancer. It can also be used to reduce tumor size preoperatively, or to destroy any remaining tumor cells postoperatively. Angiogenesis is the growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth. Fatigue and stomatitis are side effects of radiation and chemotherapy.
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 invade surrounding tissue." "Benign tumors grow very rapidly." "Benign tumors don't usually cause death." "Benign tumors can spread from one place to another." Chapter 15: Management of Patients with Oncologic Disorders - Page 326
"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.
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 use an alcohol-based mouthwash every morning." "I clean my teeth gently several times per day." "I replace my toothbrush every month." "I lubricate my lips with petroleum jelly."
"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.
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 will need to attend follow-up visits for up to 3 months after treatment." "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." "The doctor will remove cells from my bone marrow before beginning chemotherapy." "I hope they find a bone marrow donor who matches."
"I hope they find a bone marrow donor who matches." 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.
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? "I'll wear protective clothing when outside." "I'm worried I'll expose my family members to radiation." "I'll wash my skin with mild soap and water only." "I'll not use my heating pad during my treatment." Chapter 15: Management of Patients with Oncologic Disorders - Page 339
"I'm worried I'll expose my family members to radiation." Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
A patient is scheduled for cryoablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse? "The surgeon is going to use liquid nitrogen to freeze the area." "The surgeon is going to use radiofrequency to ablate the area." "The surgeon is going to use a laser to remove the area." "The surgeon is going to use medication to inject the area."
"The surgeon is going to use liquid nitrogen to freeze the area." Cryoablation is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers. Chemosurgery is the use of medication. Laser surgery is the use of a laser. Radiofrequency ablation is the use of thermal energy.
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." "Clients with alopecia will have delay in grey hair." "New hair growth will return without any change to color or texture." "Wigs can be used after the chemotherapy is completed." Chapter 15: Management of Patients with Oncologic Disorders - Page 363
-"The hair loss is usually temporary. "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.
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? Temperature of 98.3° F (36.8° C) White blood cell (WBC) count of 9,000 cells/mm3 Stage 3 pressure ulcer on the left heel Ate 75% of all meals during the day Chapter 15: Management of Patients with Oncologic Disorders, Hematopoietic System, p. 345.
-Stage 3 pressure ulcer on the left heel A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection
The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following? A psychiatric diagnosis everyone has at one time or another. A normal reaction to the diagnosis of cancer. A side effect of the neoplastic drugs. An aberrant psychologic reaction to the chemotherapy. Chapter 15: Management of Patients with Oncologic Disorders - Page 375
A normal reaction to the diagnosis of cancer. Explanation: Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy lifestyle. They also may express anger related to the diagnosis and their inability to be in control. While depression is understandable, it also needs to be acknowledged and treated if necessary. Depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? Therapeutic Autologous Allogeneic Prophylactic
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
Which occurs when fluid accumulates in the pericardial space and compresses the heart? Superior vena cava syndrome (SVCS) SIADH DIC Cardiac tamponade Chapter 15: Management of Patients with Oncologic Disorders - Page 631
Cardiac tamponade is an accumulation of fluid in the pericardial space. 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). DIC is a complex disorder of coagulation and fibrinolysis, which results in thrombosis and bleeding.
In which phase of the cell cycle does cell division occur? Mitosis G2 phase S phase G1 phase
Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase.
The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years? Fecal occult blood test Papanicolaou (Pap) Colonoscopy Prostate-specific antigen (PSA)
Colonoscopy Explanation: Recommendations for screening for colorectal cancer include a screening colonoscopy every 10 years. Fecal occult blood tests should be completed annually in people over age 50. The test for PSA is used as a screening tool for prostate cancer. A Pap test is a screening tool for cervical cancer.
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? Chapter 15: Management of Patients with Oncologic Disorders - Page 334
Control Explanation: The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication? Thrombosis Erythema Extravasation Flare
Extravasation The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.
A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client? Sexual Dysfunction Knowledge Deficit Fear Grieving Chapter 15: Management of Patients with Oncologic Disorders - Page 375
Fear Fear of the unknown is probably the major concern for this client. This includes fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual Dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Grieving would not be a likely response at this time.
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 destroys the cell membrane, causing lysis. It interferes with ribonucleic acid (RNA) transcription only. It interferes with deoxyribonucleic acid (DNA) replication only. It interferes with DNA replication and RNA transcription.
It interferes with DNA replication and RNA transcription. Thiotepa interferes with DNA replication and RNA transcription. It doesn't destroy the cell membrane.
A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? Chapter 15: Management of Patients with Oncologic Disorders - Page 350
Monitor the client to prevent sepsis. Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.
Which of the following is generally NOT considered to be a carcinogen? Dietary substances Green veggies Viruses Parasites Chapter 15: Management of Patients with Oncologic Disorders - Page 326
Parasites Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.
A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis? Check regularly for signs and symptoms of 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. Chapter 15: Management of Patients with Oncologic Disorders - Page 357
Provide a solution of viscous lidocaine for use as a mouth rinse 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.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? The hair will grow back the same as it was before treatment. The client should consider getting a wig or cap prior to beginning treatment. The hair will grow back within 2 months post therapy. Alopecia related to chemotherapy is relatively uncommon. Chapter 15: Management of Patients with Oncologic Disorders - Page 363
The client should consider getting a wig or cap prior to beginning treatment. Explanation: If hair loss is anticipated and causing the client anxiety, a wig, cap, or scarf should be purchased before therapy begins. Alopecia develops because chemotherapy affects the rapidly growing cells of the hair follicles. Hair usually begins to grow again within 4 to 6 months after therapy. Clients should know that new growth may have a slightly different color and texture.
Which statement is true about malignant tumors? They gain access to the blood and lymphatic channels. They demonstrate cells that are well differentiated. They grow by expansion. They usually grow slowly.
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.
The physician is attending to a 72-year-old client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? To destroy marginal tissues To remove the tumor from the brain To prevent the formation of new cancer cells To analyze the lymph nodes involved Chapter 15: Management of Patients with Oncologic Disorders.
To prevent the formation of new cancer cells Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present. Also, it can be used prophylactically to prevent spread. Biopsy is used to analyze lymph nodes or to destroy the surrounding tissues around the tumor.
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? Emission of abnormal proteins Tumor pressure against normal tissues Cells colonizing to distant body parts Random, rapid growth of the tumor Chapter 15: Management of Patients with Oncologic Disorders - Page 326
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.
A client is receiving radiation therapy and asks the nurse about oral hygiene. What teaching specific to the client's situation should the nurse include? Treat cavities immediately. Gargle after each meal. Use a soft toothbrush and allow it to air dry before storing. Floss before going to bed. Chapter 15: Management of Patients with Oncologic Disorders - Page 361
Use a soft toothbrush and allow it to air dry before storing. Explanation: The nurse advises the client undergoing radiation therapy to use a soft toothbrush to avoid gum lacerations and allow the toothbrush to air dry before storing. Gargling after each meal, flossing before going to bed, and treating cavities immediately are general oral hygiene instructions.
Carcinogens are factors related to the formation of various malignancies. Which factor has the greatest impact on the development of all cancers? viruses chemical agents defective genes environmental factors Chapter 15: Management of Patients with Oncologic Disorders - Page 329
chemical agents 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.
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include: Chapter 15: Management of Patients with Oncologic Disorders - Page 348
chemotherapy exposure and risk factors. Explanation: The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.
A decrease in circulating white blood cells is granulocytopenia. leukopenia. thrombocytopenia. neutropenia.
leukopenia A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low absolute neutrophil count.
Palliation refers to the spread of cancer cells from the primary tumor to distant sites. relief of symptoms associated with disease and promotion of comfort and quality of life. hair loss related to the treatment of cancer. the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.
relief of symptoms associated with disease and promotion of comfort and quality of life. Palliation is the goal for care in patients with terminal cancer. Alopecia is the term that refers to hair loss. Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites. Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.
While doing a health history, a client tells the nurse that her mother, her grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse? "With your family history, there is nothing you can do to prevent getting cancer, so be mindful of your family risk factors." "Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." "Cancer often skips a generation, so don't worry about it." "If you eat right, exercise, and get enough rest, you can always prevent breast cancer." Table 15-4 Selected Diagnostic Tests Used to Detect Cancer, p. 334. Chapter 15: Management of Patients with Oncologic Disorders - Page 334
"Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The nurse cannot say that cancer can be avoided with healthy behaviors; this is inaccurate information. A family history is a reason for the client to be concerned. Cancer does not skip a generation; this response minimizes and negates the client's concern.
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? "I floss my teeth every morning." "I use an electric razor to shave." "I take a stool softener every morning." "I removed all the throw rugs from the house."
"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 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'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 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." Chapter 15: Management of Patients with Oncologic Disorders - Page 350
"I'll only need chemotherapy treatment before receiving my bone marrow transplant." 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.
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 may choose to discontinue this test." You need to continue obtaining a Pap test for only the next 5 years." "You could have stopped immediately after your hysterectomy." "You will need to continue for the rest of your life."
"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.
A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is "You will need to practice birth control measures." "You will experience menopause now." "You will continue having your menses every month." "You will be unable to have children." Chapter 15: Management of Patients with Oncologic Disorders, Addressing Sexuality, p. 375.
"You will need to practice birth control measures." Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.
The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? Avoid intake of fluids. Avoid spicy and fatty foods. Eat warm or hot foods. Eat wholesome meals. Chapter 15: Management of Patients with Oncologic Disorders, Chart 15-7, p. 360.
Avoid spicy and fatty foods. The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.
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. Effectiveness of the antidote Sloughing tissue Active bleeding Tissue necrosis
Effectiveness of the antidote Sloughing tissue Tissue necrosis 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 nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of metastasis. acute leukopenia. graft-versus-host disease. nadir.
Graft-versus-host disease is a major cause of morbidity and mortality in clients who have had allogeneic transplant. Clinical manifestations of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent diarrhea, abdominal pain, and hepatomegaly.
What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action? Eggs and milk Green, leafy vegetables Fish and poultry Ham and bacon Chapter 15: Management of Patients with Oncologic Disorders - Page 329
Ham and bacon Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats. Nitrates are added to cured meats, such as ham and bacon.
While completing an admission assessment, the client reports a family history of ovarian cancer among a maternal grandmother, aunt, and sister. The nurse knows that these cancers are most likely associated with what etiology? Increased tumor suppressor genes Exposure to chemicals and spermicides Inherited gene mutation Smoking and tobacco use
Inherited gene mutation Tumor suppressor genes assist the body in normal cell production and death. Tobacco use and chemical carcinogens can contribute to the development of cancer, but there is not enough information provided to suggest a common link. Ontogenesis are genes that have mutated and activates out of control cell growth. Inherited gene mutation occurs when the DNA is passed to the next generation.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? Inspecting the skin for petechiae once every shift Placing the client in strict isolation Administering aspirin if the temperature exceeds 102° F (38.8° C) Providing for frequent rest periods
Inspecting the skin for petechiae once every shift Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? It stimulates the immune system against the tumor cells. It lowers serum and uric acid levels. It prevents alopecia. It treats drug-related anemia. Chapter 15: Management of Patients with Oncologic Disorders - Page 345, 383
It lowers serum and uric acid levels. 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.
What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? Chapter 15: Management of Patients with Oncologic Disorders - Page 341
It targets normal body cells as well as cancer cells. Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.
The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? Monitor the client closely to prevent infection. Monitor the client's toilet patterns. Monitor the client's heart rate. Monitor the client's physical condition. Chapter 15: Management of Patients with Oncologic Disorders - Page 349
Monitor the client closely to prevent infection. Explanation: Until transplanted stem cells begin to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.
Which type of surgery is used in an attempt to relieve complications of cancer? Prophylactic Salvage Palliative Reconstructive
Palliative Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
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? local excision palliative prophylactic cryoablation
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.
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 Chapter 15: Management of Patients with Oncologic Disorders - Page 337
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.
The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks? Hand washing and infection prevention Breast and testicular self-exams Sun safety and use of sunscreen Pool and water safety Chapter 15: Management of Patients with Oncologic Disorders - Page 328
Sun safety and use of sunscreen Explanation: Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.
A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms? Stomatitis Neutropenia Extravasation Nadir
The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to 10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.
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 have a synergistic effect and act on the cancer cells with different mechanisms. The second and third drugs increase the effectiveness of the first drug. The three drugs can be given at lower doses. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. Chapter 15: Management of Patients with Oncologic Disorders - Page 334
The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. 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.
A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with myalgia. weight gain. seizure. anorexia.
seizure. Explanation: A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium concentrations lower than 120 mEq/L.
A client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply. teaches the client to report abdominal or bone pain restricts fluids to 1500 mL per day asks about nausea and vomiting provides information about antidiarrheal medication instructs the client to discontinue calcium
teaches the client to report abdominal or bone pain asks about nausea and vomiting instructs the client to discontinue calcium The client with cancer is at risk for hypercalcemia from bone breakdown. The client should not take an over-the-counter calcium supplement that would increase blood levels of calcium. Signs and symptoms of hypercalcemia include nausea and vomiting. The client may also report abdominal or bone pain with cancer. The client should increase fluid intake to 2 to 4 L per day. Intake would have to be adjusted based on the client's other medical conditions. GERD would not negate an increase in fluid intake. The client most likely would have constipation with hypercalcemia, not diarrhea.