PrepU Unit F Review: Cancer

A patient with a diagnosis of late-stage bladder cancer has experienced a steady decline in his platelet counts, which are currently 18,000/mm3 (0.018 × 1012/L). Which of the following nursing actions best accommodates the health risks associated with this laboratory finding?

Encouraging the patient to increase his fluid intake and providing stool softeners A platelet count of 18,000/mm3 (0.018 × 1012/L) constitutes thrombocytopenia and creates a significant risk of bleeding. To mitigate the potential for GI bleeding, the patient should increase his fluid intake and use stool softeners. Activity management, high protein intake, and good infection control practices do not directly address the consequences of thrombocytopenia.

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action?

Place the client in a private room. Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.

Which of the following is the single largest preventable cause of cancer?

Tobacco Tobacco remains the single largest preventable cause of disease and early death and accounts for at least 30% of all cancer deaths. The list of suspected carcinogens, such as pesticides, arsenic, and asbestos, continues to grow.

The nurse is responsible for teaching the patient who is receiving head and neck radiation how to protect his mouth. Which of the following teaching points should be included? Select all that apply.

Use a bland mouth rinse before and after meals and at bedtime. Avoid carbonated and caffeinated beverages. Use fluoride preparations daily. Using a bland mouthwash and fluoride preparations, as well as avoiding carbonated and caffeinated beverages, will help protect the mouth. All acidic fruits and juices should be avoided, such as orange, tomato, lemon, grapefruit, and pineapple.

Palliation refers to

relief of symptoms of disease and promotion of comfort and quality of life. Palliation is the goal for care of clients 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.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?

Adjuvant therapy is likely. 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.

The nurse provides care on an oncology unit, where many patients undergo surgery during cancer treatment and face a particularly high risk of deep vein thrombosis (DVT) because of an increase in circulating procoagulants. The nurse should prioritize which type of assessments?

Limb symmetry and calf pain Approximately 50% of patients with DVT are asymptomatic. The nurse should inquire about an ache or pain in the calf, aggravated by standing or walking. In addition, it is important to assess for asymmetry of the limbs, as slight swelling may be noted as well as erythema and warmth of the involved extremity. Petechiae, hematomas, nausea, and altered range of motion are not typically associated with the onset of a DVT.

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

diminished or absent breath sounds on the affected side. In the case of a pneumothorax, auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Tracheal deviation occurs in a tension pneumothorax. Muffled or distant heart sounds occur in cardiac tamponade.

An oncology nurse is contributing to the care of a client who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRMs). The nurse should know that these achieve a therapeutic effect by what means?

Altering the immunologic relationship between the tumor and the client BRMs alter the immunologic relationship between the tumor and the cancer client (host) to provide a therapeutic benefit. They do not necessarily increase white cell production or focus the immune system solely on the tumor. BRMs do not potentiate radiotherapy and chemotherapy.

You are giving a report in your pathophysiology class. The subject of your report is cancer cells. In differentiating between benign and malignant cells, what characteristics would you cite? Select all that apply.

Rate of growth Ability to cause death Ability to spread Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are essentially similar but their behavior is different.

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?

Use a soft toothbrush and allow it to air dry before storing. 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.

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 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.

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 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 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." The client requires additional teaching if he mentions that he will lose the hair on his head as a result of radiation therapy. Alopecia is an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of his lungs, not his head. Nausea and fatigue are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete.

The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. What response by the nurse would best reassure this patient?

"These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and X-ray studies." Fatigue and weakness result from radiation treatment and usually don't represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and shouldn't be belittled. Radiation destroys both cancerous and normal cells.

Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer?

Biopsy of the axillary lymph nodes The transport of tumor cells through the lymphatic circulation is the most common mechanism of metastasis. Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates with lymphatic circulation. Breast tumors frequently metastasize in this manner through axillary, clavicular, and thoracic lymph channels.

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 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 client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the right arm, and the client's left arm and hand should be elevated as much as possible to prevent which condition?

Lymphedema Lymphedema is a common postoperative effect of modified radical mastectomy and lymph node dissection. Elevation of the left arm and hand will allow gravity to assist lymph drainage. Other preventive measures include exercises in which the arms are elevated. Trousseau's sign is a sign of hypocalcemia and isn't an expected finding in this situation. IV infusions shouldn't be given in the left arm nor should venipunctures be done in this arm. Although muscle atrophy is a potential adverse effect if the client doesn't exercise her left arm, it wouldn't be prevented by elevation.

A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The client has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this client most likely undergo?

Sentinel node biopsy Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer.

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 Effectiveness of the antidote 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.

Which of the following are true statements about effective radiation therapy? Select all that apply.

Slower-growing tissues at rest (muscle) are more radioresistant. Tumors that are well oxygenated are more sensitive to radiation. Tumors that are small in size and dividing rapidly are more sensitive. All of the statements are true except for A. Cells are most vulnerable during DNA synthesis and mitosis. Tissues that experience frequent cellular division are most sensitive to radiation.