Ch 6 - Cancer Care: PrepU
The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue? 75% 65% 95% 85%
95%
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 normal reaction to the diagnosis of cancer. An aberrant psychologic reaction to the chemotherapy. A side effect of the neoplastic drugs. A psychiatric diagnosis everyone has at one time or another.
A normal reaction to the diagnosis of cancer.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? No further treatment is indicated. Repeat biopsy is needed before treatment begins. Palliative care is likely. Adjuvant therapy is likely.
Adjuvant therapy is likely.
Which oncologic emergency involves the accumulation of fluid in the pericardial space? Tumor lysis syndrome Syndrome of inappropriate antidiuretic hormone release (SIADH) Disseminated intravascular coagulation (DIC) Cardiac tamponade
Cardiac tamponade
A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? Monitor daily platelet counts. Perform a cardiovascular assessment every 4 hours. Check the client's history for a congenital link to thrombocytopenia. Closely observe the client's skin for petechiae and bruising.
Closely observe the client's skin for petechiae and bruising.
The drug interleukin-2 is an example of which type of biologic response modifier? Cytokine Antimetabolites Retinoids Monoclonal antibodies
Cytokine
Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression? Increased creatinine and blood urea nitrogen (BUN) Decreased platelets and red blood cells Increased white blood cells and c-reactive protein (CRP) Decreased sodium levels and decreased potassium levels
Decreased platelets and red blood cells
While administering an intravenous chemotherapeutic medication to a client, the nurse assesses swelling at the insertion site. What is the nurse's first action? Apply a warm compress. Discontinue the intravenous medication. Aspirate as much of the fluid as possible. Administer a neutralizing solution.
Discontinue the intravenous medication.
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? Erythema Thrombosis Extravasation Flare
Extravasation
The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? Use disposable utensils for the next month. Shield your throat area when near others. Flush the toilet several times after every use. Prepare food separately from family members.
Flush the toilet several times after every use.
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? Green, leafy vegetables Fish and poultry Eggs and milk Ham and bacon
Ham and bacon
A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to: Report the unexpected sign of increased appetite and weight gain. Increase her intake of calcium-rich foods. Be alarmed if she notices fluid retention. Report the unusual sign of nausea.
Increase her intake of calcium-rich foods.
Chemotherapeutic agents have which effect associated with the renal system? Hypercalcemia Hypophosphatemia Increased uric acid excretion Hypokalemia
Increased uric acid excretion
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? Time, distance, and shielding Avoid showering or washing over skin markings. The use of disposable utensils and wash cloths Inspect the skin frequently.
Inspect the skin frequently.
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 Administering aspirin if the temperature exceeds 102° F (38.8° C) Providing for frequent rest periods Placing the client in strict isolation
Inspecting the skin for petechiae once every shift
A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician orders mitomycin and other chemotherapeutic agents for palliative treatment. How does mitomycin exert its cytotoxic effects? It's cell cycle-phase specific. It inhibits deoxyribonucleic acid (DNA) synthesis. It inhibits ribonucleic acid (RNA) synthesis. It inhibits protein synthesis.
It inhibits deoxyribonucleic acid (DNA) synthesis.
A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? White blood cells (WBCs) Liver Reproductive tract Colon
Liver
The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? Malignant tumor with metastasis to surrounding tissue Malignant tumor Benign fibrocystic disease Normal finding
Malignant tumor
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 bone marrow transplant? Monitor the client's toilet patterns. Monitor the client's heart rate. Monitor the client's physical condition. Monitor the client closely to prevent infection.
Monitor the client closely to prevent infection.
As a nurse who provides care for many patients with cancer, you are aware that cancer makes patients susceptible to many other health problems. Which of the following assessments addresses the leading cause of death among patients who have cancer? Arranging for serial electrocardiograms (ECGs) or cardiac telemetry whenever possible Auscultating patients' lungs thoroughly and monitoring oxygen saturation levels Assessing patients' lower legs for redness, swelling, or pain on dorsiflexion Monitoring white blood cell (WBC) counts and assessing patients' integumentary systems
Monitoring white blood cell (WBC) counts and assessing patients' integumentary systems
A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis? Risk for infection related to inadequate defenses Activity intolerance related to side effects of chemotherapy Fatigue related to deficient blood cells Anxiety related to change in role function
Risk for infection related to inadequate defenses
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? Ability to invade other tissues Undifferentiated cells Causes generalized symptoms Slow rate of growth
Slow rate of growth
A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately Places the client on oxygen by nasal cannula Gives prednisolone IV Administers diphenhydramine Stops the chemotherapeutic infusion
Stops the chemotherapeutic infusion
Which of the following would be inconsistent as a common side effect of chemotherapy? Myelosuppression Fatigue Alopecia Weight gain
Weight gain
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as a contact mold. brachytherapy. systemic radiation. external beam radiation therapy.
brachytherapy.
The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply. environmental factors age dietary substances gender viruses
dietary substances environmental factors viruses
The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply. viruses environmental factors defective genes dietary substances hormone replacement therapy chemical agents
dietary substances environmental factors viruses chemical agents defective genes hormone replacement therapy
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? uses the treadmill for 30 minutes on 5 days each week works as a secretary at a medical radiation treatment center drinks one glass of wine at dinner each night eats red meat such as steaks or hamburgers every day
eats red meat such as steaks or hamburgers every day
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 acute leukopenia. graft-versus-host disease. nadir. metastasis.
graft-versus-host disease.
A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through: absorption through the goggles. absorption through the gown. inhalation of aerosols. absorption through the gloves.
inhalation of aerosols.
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 removed all the throw rugs from the house." "I use an electric razor to shave." "I take a stool softener every morning." "I floss my teeth every morning."
"I floss my teeth every morning."
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 receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." "I will need to attend follow-up visits for up to 3 months after treatment." "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."
The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective? "I will limit alcoholic beverages to one a day." "I will brush my teeth after every meal." "I will eat spicy foods with a cool beverage." "I will reduce smoking to after meals only."
"I will brush my teeth after every meal."
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? "I'm worried I'll expose my family members to radiation." "I'll wear protective clothing when outside." "I'll wash my skin with mild soap and water only." "I'll not use my heating pad during my treatment."
"I'm worried I'll expose my family members to radiation."
A 66-year-old man is receiving radiation therapy and chemotherapy for the treatment of small cell lung cancer. The nurse has assessed him many times since he was admitted to the hospital. This morning, he admits that his greatest challenge he is currently facing is his overwhelming fatigue. How should the nurse respond to this patient's statement? "Your fatigue is actually a sign that your body is redirecting its energies toward healing and away from more common functions like mobility." "I'm sure you'll agree that fatigue, even when it's severe, is much preferable to pain. It's fortunate that your pain is now well-controlled." "That's entirely normal, given what your body is going through and how much treatment you're currently getting." "That must be incredibly difficult for you. How would you rate your fatigue if you had to give it a number from 1 to 10?"
"That must be incredibly difficult for you. How would you rate your fatigue if you had to give it a number from 1 to 10?"
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? "Wigs can be used after the chemotherapy is completed." "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."
"The hair loss is usually temporary."
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 could have stopped immediately after your hysterectomy." "You may choose to discontinue this test." "You will need to continue for the rest of your life." You need to continue obtaining a Pap test for only the next 5 years."
"You may choose to discontinue this test."
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 experience menopause now." "You will be unable to have children." "You will continue having your menses every month." "You will need to practice birth control measures."
"You will need to practice birth control measures."
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? Autologous Syngeneic Allogeneic Homogenic
Allogeneic
The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? An aunt and uncle diagnosed with cancer A second cousin diagnosed with cancer A first cousin diagnosed with cancer Onset of cancer after age 50 in family member
An aunt and uncle diagnosed with cancer
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? Serial bone marrow biopsies Gauging her response to radiation therapy Biopsy of the axillary lymph nodes Careful grading of the tumor cells
Biopsy of the axillary lymph nodes
The patient diagnosed with thrombocytopenia is at risk for which of the following adverse effects: Bleeding Stomatitis Headache Diminished reflexes
Bleeding
Which type of surgery is used in an attempt to relieve complications of cancer? Palliative Prophylactic Reconstructive Salvage
Palliative
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Initiation Promotion Progression Prolongation
Progression
A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? Clarify information provided by the physician. Provide time for the patient to discuss her concerns. Provide aseptic care to the incision postoperatively. Counsel the patient about the possibility of losing her breast.
Provide time for the patient to discuss her concerns.
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? The laboratory reports a white blood cell (WBC) count of 1,000/mm3. The client states he is nauseous. The I.V. site is red and swollen. The client begins to shiver.
The I.V. site is red and swollen.
Which statement is true about malignant tumors? They demonstrate cells that are well differentiated. They gain access to the blood and lymphatic channels. They grow by expansion. They usually grow slowly.
They gain access to the blood and lymphatic channels.
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? Fatigue To prevent metastasis Stomatitis Angiogenesis
To prevent metastasis
When addressing a community group, the nurse identifies consumption of which substance(s) as a risk factor for the development of cancer? Select all that apply. Alcohol Tobacco Processed meats Cruciferous vegetables Organic grown orange vegetables
Tobacco Processed meats Alcohol
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? Cells colonizing to distant body parts Random, rapid growth of the tumor Emission of abnormal proteins Tumor pressure against normal tissues
Tumor pressure against normal tissues
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. Floss before going to bed. Use a soft toothbrush and allow it to air dry before storing.
Use a soft toothbrush and allow it to air dry before storin
Which of the following would be consistent with a benign neoplasm? Gains access to the blood and lymph channels to metastasize Grows by invasion Cells are undifferentiated Usually progressive and slow
Usually progressive and slow
According to the TNM classification system, T0 means there is: no evidence of primary tumor. no distant metastasis. distant metastasis. no regional lymph node metastasis.
no evidence of primary tumor.
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 cryosurgery prophylactic
prophylactic
A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with anorexia. weight gain. seizure. myalgia.
seizure.
