Chapter 15: Cancer Treatment and Care; Medical-Surgical Nursing Adaptive Quizzing

The patient is receiving biologic and targeted therapy for cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A. Ibuprofen B. Ondansetron C. Acetaminophen D. Morphine sulfate

C. Acetaminophen is administered before therapy and every four hours after to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon, which frequently is used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms such as headache, fever, chills, and myalgias. p. 259

The nurse is reviewing the medical record of a patient who has been newly diagnosed with 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.

B. When cure is the goal, treatment is expected to have the greatest chance of disease eradication. Curative cancer therapy differs according to the particular cancer being treated and may involve local therapies (i.e., surgery or radiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy). In general, the risk for recurrent disease is highest after treatment completion, and gradually decreases the longer the patient remains disease free following treatment. Chemotherapy is not always the initial treatment for cancer. p. 243

A patient who is undergoing a diagnostic workup for cancer expresses anxiety about the results. Which is the best nursing response? A. "It is probably nothing." B. "Let's discuss that later." C. "Everyone feels that way." D. "Let's talk about your concerns."

D. During the diagnostic workup of cancer, it is common for patients to be anxious. The nurse should actively listen to all concerns expressed. The nurse should not use communication patterns that may hinder exploration of feelings and meanings. "It is probably nothing" may indicate that the nurse is giving false reassurances. "Let's discuss that later" may mean that the nurse is delaying the discussion, and "Everyone feels this way" means that the nurse is generalizing the patient's concern. By using these strategies, the nurse may deny patients the opportunity to share the meaning of their experience. p. 265

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.

D. Infiltration of chemotherapy agents will cause tissue damage, and mechlorethamine hydrochloride is especially destructive to tissues. The IV infusion needs to be stopped, but the cannula is left in place so the extravasation antidote, 10% sodium thiosulfate in sterile water, can be administered. With this particular chemotherapy agent, the IV line should not be removed even though the infusion is stopped. Because the IV site is suspected of being infiltrated, the infusion should be stopped immediately, not slowed. The vital signs should be monitored. p. 246

A patient is diagnosed with early stages of cancer. What interventions are most appropriate for the nurse to focus at this time? Select all that apply. A. Maintain the patient's hope. B. Listen actively to the patient's fears and concerns. C. Assist the patient in maintaining usual lifestyle patterns. D. Discuss replacement child care for the patient's children. E. Explain in detail the aspects of the upcoming radiation therapy.

A, B, C. Provide essential information (not extreme details) regarding cancer and cancer care that is accurate and establishes realistic expectations about what the patient will experience. Maintaining hope is the key to effective cancer care. Hope varies, depending on the patient's status: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, hope to achieve meaningful goals, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care. It is also important to assist the patient in maintaining usual lifestyle patterns as much as possible. Discussing replacement child care is not appropriate at this time. p. 265

A patient with cancer presents with weight gain without edema, anorexia, and oliguria. Which nursing measures would help to relieve the patient's symptoms? Select all that apply. A. Encourage fluid intake. B. Administer furosemide. C. Withhold demeclocycline. D. Administer 0.9% saline solution. E. Administer 3% sodium chloride solution.

A, B, D, E. The presence of weight gain without edema, anorexia, and oliguria in a patient with cancer of the esophagus is suggestive of syndrome of inappropriate antidiuretic hormone (SIADH). It involves increased secretion of antidiuretic hormone (ADH). The management involves administering furosemide in the initial stages to facilitate excretion of excess fluid. Isotonic solutions like 0.9% saline solution are administered in mild cases to prevent dehydration; 3% saline solution is administered in severe cases. Patients should have fluid restrictions. Demeclocycline is helpful in moderate cases of SIADH.

A nurse is caring for a patient experiencing severe side effects of chemotherapy. On examination, the nurse notices stomatitis. Which interventions should the nurse perform to relieve stomatitis? Select all that apply. A. Apply topical anesthetics. B. Encourage nutritional supplements. C. Give diuretics and laxatives regularly. D. Encourage oral application of alcohol. D. Discourage the use of oral irritants like tobacco.

A, B, D. Stomatitis is an inflammation of the mouth. It occurs when the epithelial cells get damaged due to chemotherapy or radiation therapy. Topical anesthetics such as viscous lidocaine may be used to provide local pain relief. Nutritional supplements help to meet the nutritional demands when the food intake decreases due to stomatitis. Giving diuretics and laxatives regularly promotes bladder and bowel elimination, but does not help in relieving stomatitis. Oral application of alcohol may have a drying effect on the mucosa and may worsen stomatitis. Use of oral irritants like tobacco should be discouraged because they can worsen stomatitis and increase discomfort. p. 215

A patient with cancer develops sudden onset of chest heaviness, shortness of breath, tachycardia, hoarseness, and a reduced level of consciousness with muted heart sounds. The nurse expects that the immediate treatment plan for this patient will include what interventions? Select all that apply. A. Administration of IV hydration B. Administration of vasodilators C. Administration of oxygen therapy D. Placement of a pericardial catheter E. Surgical establishment of a pericardial window

A, C, D, E. Sudden onset of heaviness in the chest, shortness of breath, tachycardia, hoarseness, and a reduced level of consciousness with muted heart sounds are suggestive of cardiac tamponade. The nurse manages this patient by administering oxygen to promote tissue oxygenation. A pericardial catheter or surgical establishment of a pericardial window is necessary to relieve pressure from the heart. The patient should be given IV hydration for maintaining fluid balance. The patient should be administered vasopressor therapy, not vasodilators, to avoid a fall in blood pressure. p. 263

A nurse caring for a patient with cancer receiving chemotherapy has developed alopecia and is noticeably upset. Which nursing actions are appropriate for this patient? Select all that apply. A. Suggest the patient use scarves and wigs. B. Instruct the patient to use shampoo every day. C. Suggest the patient cut long hair before therapy. D.Instruct the patient to avoid the use of hair dryers. E. Instruct the patient to brush and comb hair frequently.

A, C, D. Alopecia refers to loss of hair from the head or the body and is a common side effect of cancer treatment. The patient can use scarves and wigs to improve body image. Long hair should be cut before therapy, because it needs more care and is more prone to fall out. Hair dryers should be avoided because their use can worsen alopecia. Shampoos are chemicals that may harm the hair and should not be used daily. Brushing and combing should be done carefully and infrequently because excessive brushing and combing can worsen alopecia. p. 256

A patient with cancer is receiving radiation therapy. A nurse finds that the patient has developed anemia as a side effect of radiation therapy. What interventions are appropriate for this patient? Select all that apply. A. Monitor hemoglobin and hematocrit levels. B. Monitor WBC count, especially neutrophils. C. Administer iron supplements and erythropoietin. D. Promote foods that increase hemoglobin levels. E. Teach the patient to avoid large crowds and people with infections.

A, C, D. The hemoglobin and hematocrit levels should be monitored to determine the severity of anemia and the effectiveness of the treatment. Iron supplements and erythropoietin are administered to increase hemoglobin levels. Promoting foods that increase hemoglobin levels help to treat anemia. Monitoring WBC counts and teaching the patient to stay away from crowds are management techniques done in cases of leukopenia. p. 253

A patient with cancer has been treated with an anticancer drug that has a high propensity to cause myelosuppression. What nursing interventions would be helpful to this patient? Select all that apply. A. Monitoring the platelet count B. Monitoring the basophil count C. Monitoring the neutrophil count D. Monitoring the eosinophil count E. Monitoring the red blood cell (RBC) count

A, C, E. Monitoring the RBC count helps the nurse to detect the severity of anemia and assess the need for administering RBC growth factors or an RBC transfusion. Monitoring the platelet count helps to detect the risk of bleeding in the patient and the need for using platelet growth factors or a platelet transfusion. Monitoring the neutrophil count helps to detect the risk of infection and the need for using white blood cell (WBC) growth factors and measures to prevent infection. Eosinophil and basophil counts should be assessed only in patients who have an allergic predisposition or if the drug is known to produce allergic reactions. p. 253

When caring for a patient undergoing chemotherapy, which nursing actions should the nurse take to manage fatigue in the patient? Select all that apply. A. Pace activities in accordance with energy level. B. Encourage strenuous exercise to build strength. C. Encourage the patient to be active even when tired. D. Maintain usual lifestyle patterns as much as possible. E. Reassure the patient that fatigue is a common side effect.

A, D, E. Fatigue is common during cancer treatment, and the patient can be helped to manage it. The nurse should reassure the patient that fatigue is a side effect of treatment that may subside once the treatment is over. Energy-conserving strategies should be adopted, and the patient should pace activities in accordance with his or her energy level, resting when necessary. The patient should maintain usual lifestyle patterns as much as possible and avoid strenuous exercise, instead doing mild or moderate exercise, if possible. p. 253

A nurse is caring for a patient with cancer. The patient's laboratory reports reveal a platelet level of 19,000/μL. What nursing actions will help prevent bleeding complications associated with this lab finding? Select all that apply. A. Avoid invasive procedures. B. Ensure proper hand washing. C. Include iron-rich food in the diet. D. Obtain a prescription for a platelet transfusion. E. Instruct the patient to avoid activities that increase the risk of injury.

A, D, E. The patient is at increased risk of bleeding because the platelet levels are below 20,000/μL. The nurse should avoid any invasive procedures because they can cause bleeding. Platelet transfusion should be performed to increase the platelet levels. The patient should avoid all activities that increase the risk of injury and bleeding because even a minor injury can result in huge blood loss. Proper hand washing should be performed before and after handling any patient; however, it does not help to decrease the bleeding risk. Including iron-rich food in the diet helps to manage anemia, but may not be helpful in decreasing the risk of bleeding. p. 253

A patient with cancer develops headaches, facial edema, periorbital edema, and distention of the veins in the head, neck, and chest. The nurse expects that what will be included in the patient's treatment plan? Select all that apply. A. Prepare the patient for radiation therapy. B. Administer a narcotic and reassure the patient. C. Administer a diuretic agent and reassure the patient. D. Inform the patient that chemotherapy may be required. E. Inform the patient that the symptoms are due to obstruction of the bronchus.

A, D. A cancer patient who presents with headaches, facial edema, periorbital edema, and distension of veins of the head, neck, and chest is indicative of superior vena cava syndrome. Management of this condition involves treating the patient with localized radiation therapy. If the cancer is sensitive to drugs, then the patient may also be treated with chemotherapy. Superior vena cava syndrome is a medical emergency; hence, just administering a pain killer and diuretic will only provide symptomatic relief without any effect on disease progression. Superior vena cava syndrome is due to obstruction of the superior vena cava and not the bronchus. p. 263

A patient with multiple myeloma presents with sudden onset of depression, fatigue, muscle weakness, polyuria, nocturia, and vomiting. The serum calcium level is in excess of 12 mg/dL. The nurse recognizes that which treatments could be helpful for the patient? Select all that apply. A. Adequate hydration B. Administration of mesna C. Administration of allopurinol D. Administration of demeclocycline E. Infusion of bisphosphonate zoledronate

A, E. The clinical features of depression, fatigue, muscle weakness, polyuria, nocturia, and vomiting in a patient suffering from multiple myeloma are suggestive of hypercalcemia. Interventions for this condition involve adequate hydration and using bisphosphonate zoledronate to prevent formation of calcium stones in the kidney. Mesna is used for the treatment of hemorrhagic cystitis. Allopurinol is useful for managing tumor lysis syndrome and not hypercalcemia. Demeclocycline is used for treating syndrome of inappropriate antidiuretic hormone. p. 263

The nurse is performing an assessment on a patient who is taking chemotherapy observes loss of hair in small round areas on the scalp. How will the nurse document this assessment? A. Alopecia B. Exotropia C. Seborrhea D. Amblyopia

A. Alopecia is the correct term used for hair loss. Exotropia is a form of strabismus in which the eyes deviate outward. Seborrhea, also known as dandruff, is a form of inflammation of the skin resulting in redness and flaking. It may be seen on any part of the body but is usually seen on the scalp. Amblyopia is a visual disturbance characterized by poor vision in one eye with or without structural abnormalities. p. 256

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.

A. In external beam radiation therapy, gamma radiation is focused toward the treatment field. The patient does not absorb or retain any of the radiation particles during the treatment and is therefore not radioactive during or after the treatment period. A patient is only radioactive when there is some form of internal radiation, such as brachytherapy, as a sealed source, or an unsealed liquid radioactive source. These sources have short half-lives and are weak emitters. In these types of radiation treatments, stool and urine and blood will emit some radiation. The principles of ALARA (as low as reasonably achievable) and TDS (time, distance, and shielding) should always be followed. p. 250

The nurse is administering a vesicant chemotherapy agent to a patient who has cancer. During rounds, the nurse notes that the intravenous site is reddened and swollen, and the patient reports that it is painful. What is the first action the nurse will take? A. Turn off the infusion. B. Slow the infusion rate. C. Check the patient's vital signs. D. Notify the primary health care provider.

A. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. Immediately turn off the infusion and follow protocols for drug-specific extravasation procedures to minimize further tissue damage. It is not appropriate to slow the infusion rate. The health care provider should be notified and vital signs checked, but they are not the first action that should be taken. p. 246

A patient is receiving an infusion of monoclonal antibodies (MoAb) for non-Hodgkin's lymphoma. The nurse determines the patient is experiencing an anaphylactic reaction. Which action should the nurse perform first? A. Stop the infusion. B. Reduce the rate of the infusion. C. Inform the health care provider. D. Stabilize the airway, breathing, and circulation.

A. Monoclonal antibodies are a type of targeted therapy used for treating non-Hodgkin's lymphoma and chronic lymphocytic leukemia. Some patients may develop an anaphylactic reaction during the therapy, which can be life-threatening. If the patient develops such anaphylaxis, the infusion should immediately be stopped to prevent worsening of the anaphylactic reaction. Reducing the dose may also worsen the anaphylaxis. The airway, breathing, and circulation can be stabilized once the infusion is stopped. The primary health care provider can be informed once the infusion is stopped and the patient is stabilized. p. 258

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

A. Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. High protein, high calorie, and whole and organic foods do not prevent diarrhea. p. 254

A patient with cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the best response by the nurse? A. "What are your feelings about being so sick and thinking you may die soon?" B. "None of us knows when we are going to die. Is this a particularly difficult day?" C. "Would you like for me to call your spiritual advisor so you can talk about your feelings?" D. "Perhaps you are depressed about your illness; I will speak to the health care provider about getting some medications for you."

A. The best response to psychosocial questions is to acknowledge the patient's feelings and explore his or her concerns. "What are your feelings about being so sick and thinking you may die soon?" does both and is a helpful response that encourages further communication between patient and nurse. Calling the spiritual advisor is permissible; however, this does not increase communication and rapport between the patient and the nurse. The patient is expressing feelings; medication is not indicated for this. Ignoring the patient's feelings is not therapeutic communication. p. 265

A patient undergoing outpatient chemotherapy reports feeling lonely and isolated and expresses the desire to resume normal activities, such as socialization with friends. Which precaution should the nurse recommend when allowing the patient to resume these activities? A. Avoiding crowds B. Drinking only bottled water C. Refraining from eating outside the home D. Using the bathroom at home, not in public places

A. The nurse needs to teach the patient measures that will protect against infection, such as maintaining adequate nutrition and fluid intake and avoiding crowds, people with infections, and others who have been recently vaccinated with live or attenuated vaccines. Drinking bottled water, eating only at home, and using the bathroom only at home are unnecessary precautions. p. 253

The nurse is caring for a patient with Hodgkin's disease who has developed thrombocytopenia after receiving chemotherapy. What is the outcome of highest priority in the nursing plan of care? A. Controlling bleeding B. Controlling diarrhea C. Controlling infection D. Controlling hypotension

A. Thrombocytopenia is a low platelet count that leaves the patient at high risk for life-threatening spontaneous hemorrhage. Diarrhea and infection are not symptoms associated with thrombocytopenia. Hypotension may be seen if hemorrhagic or hypovolemic shock develops as a result of blood loss stemming from thrombocytopenia. p. 253

A nurse is caring for a patient with 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.

B, C, D, E. Anorexia refers to a decrease in appetite and is a common side effect of chemotherapy. It increases the risk of malnutrition in the patient. The nurse should monitor the weight of the patient frequently to determine any weight loss. Nutritional supplements can be used to meet the increased demand of nutrients due to cancer and its treatment. The patient's food should be high in calories and proteins to meet the energy requirements and compensate for the protein loss due to cell lysis. Nausea and vomiting are symptoms of anorexia and should be managed to promote food intake. Small and frequent meals are better tolerated than large meals. p. 261

A patient with cancer presents with intense, localized, persistent back pain and motor and sensory disturbances. What nursing interventions would be helpful to this patient? Select all that apply. A. Withhold narcotics. B. Administer corticosteroids. C. Prepare the patient for a laminectomy. D. Prepare the patient for radiation therapy. E. Encourage a graded increase in patient activity.

B, C, D. A cancer patient with symptoms of intense, persistent, and localized back pain associated with motor and sensory disturbances is suggestive of spinal cord compression. Therefore this patient would require administration of corticosteroids, radiation therapy, and surgical decompression (laminectomy). Corticosteroids help to prevent inflammation related to the spinal cord compression. Radiation therapy helps to control metastasis. Surgical decompression helps to relieve the pressure from the nerves and provide relief from symptoms. To provide symptomatic relief, the patient needs to be immobilized and administered pain killers. p. 264

A patient is treated with radiation therapy for 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.

B, C, E. Radiation therapy may cause skin changes due to desquamation, and the skin is prone to infection. The nurse should avoid extreme temperatures on the affected area. Heating pads may cause burns and should be avoided. Constricting garments may traumatize the skin and should be avoided. Rubbing the affected area may also traumatize the skin and should be avoided. Ice packs may cause damage to the affected skin. Deodorants are chemicals and may irritate and traumatize the affected area, and should be avoided. p. 255

A nurse is caring for a patient receiving chemotherapy is experiencing nausea and vomiting. What explanation does the nurse give to the patient related to these side effects? Select all that apply. A. Depression of bone marrow B. Release of intracell breakdown products C. Destruction of gastrointestinal (GI) lining D. Release of TNF and IL-1 from macrophages E. Precipitation of metabolites of cell breakdown

B, C. Nausea and vomiting are common side effects of chemotherapy. These are caused when the intracell breakdown products formed in response to chemotherapy stimulate the vomiting center in the brain. Destruction of the gastrointestinal (GI) lining as a result of chemotherapy may interfere with the digestion process and cause nausea and vomiting. Release of tumor necrosis factors (TNF) and interleukin-1 (IL-1) from macrophages has an appetite-suppressing action and tends to cause anorexia. Precipitation of metabolites of cell breakdown may cause nephrotoxicity. Depression of bone marrow does not cause nausea and vomiting; it may cause anemia, leukopenia, and thrombocytopenia. p. 253

A patient with advanced cancer experiences fatigue, weakness, nausea, and vomiting. The patient's blood report shows a high level of calcium in the blood. How should the nurse interpret this lab finding? A. The patient has cardiac tamponade. B. The patient has a metabolic emergency. C. The patient has a third space syndrome. D. The patient has a spinal cord compression syndrome.

B. Advanced cancers may result in metastasis to the bones and cause increased levels of calcium in the blood. They may manifest as apathy, depression, fatigue, muscle weakness, ECG changes, polyuria and nocturia, anorexia, nausea, and vomiting. If untreated, these may result in nephrocalcinosis and irreversible renal failure. Cardiac tamponade manifests in a heavy feeling over the chest, shortness of breath, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive perspiration, decreased level of consciousness, distant or muted heart sounds, and extreme anxiety. Spinal cord compression syndrome manifests as intense, localized, and persistent back pain. The pain may be accompanied by vertebral tenderness. Third space syndrome manifests as low blood pressure, increased heart rate, low central venous pressure, and decreased urine output. p. 278

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

B. Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation the infusion first should be stopped, then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline. p. 246

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.

B. Carotid artery rupture is a common complication in cancers of the head and neck. The artery can rupture due to invasion of the blood vessel wall by the tumor. It can also be caused by erosion of the arterial wall following surgery or radiation therapy. In the case of bleeding at the carotid artery, the nurse should immediately apply pressure on the bleeding site to stop bleeding. Intravenous fluids should be administered to maintain the intravascular volume; however, this intervention is not the priority. A blood transfusion may be necessary; however, it is not a priority. The primary health care provider should be informed after pressure is applied to the site of the bleeding. p. 264

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.

B. Chemotherapy may suppress the proliferation of bone marrow, resulting in neutropenia, or low white blood cell counts. Low WBC count makes the patient prone to developing infections; therefore, the nurse should consult the health care provider and get WBC growth factors administered. In addition, the nurse should monitor the temperature of the patient because it can indicate fever. The number of visitors should be limited to prevent risk of infection. The chemotherapy dose need not be reduced, because neutropenia is a common side effect. Respiratory rate is routinely monitored, but in this case it is not directly related to the patient's WBC. p. 253

A patient with multiple myeloma is sleeping most of the day, has no energy or appetite, and does not seem to care about anything. The patient also reports nocturia. Which complication of cancer is this most likely caused by? A. Hypokalemia B. Hypercalcemia C. Tumor lysis syndrome D. Spinal cord compression

B. Hypercalcemia can occur with multiple myeloma. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, ECG changes, polyuria and nocturia, anorexia, nausea, and vomiting. Serum levels of calcium in excess of 12 mg/dL (3 mmol/L) often produce symptoms, and significant calcium elevations can be life threatening. The symptoms are not indicative of tumor lysis syndrome, spinal cord compression, or hypokalemia. p. 263

Which item would be most beneficial when providing oral care to a patient with cancer who is at risk for oral-tissue injury? A. Use of oral swabs only B. Soft-bristled toothbrush C. Hydrogen peroxide rinses D. Alcohol-based mouthwash

B. Soft-bristled toothbrushes will prevent further irritation to oral tissue that is fragile. Alcohol-based mouthwash and hydrogen peroxide may further damage fragile oral tissue. Oral swabs may be used; however, these are not as effective in cleaning the oral cavity and teeth and reducing bacteria accumulation in the mouth. p. 251

A patient on chemotherapy for eight weeks started at a weight of 130 lb. The patient now weighs 125 lb and complains that he or she cannot taste food anymore. Which nursing interventions would be a priority? A. Advise the patient to try foods that are fatty, fried, or high in calories. B. Suggest that the patient try foods with various spices and seasonings that are not spicy. C. Advise the patient to drink a nutritional supplement beverage at least five times a day. D. Confer with the primary health care provider about the need for parenteral or enteral feedings.

B. Tell the patient to experiment with spices and other seasoning agents in an attempt to mask the taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and ham may enhance the taste of vegetables. It is not recommended for a patient to eat foods high in fat and fried. It is not necessary for the patient to drink nutritional supplements five times daily. The patient does not need parenteral or enteral feedings at this point. p. 254

The nurse is reviewing the laboratory test results for a patient with cancer. The total serum protein level is 6.4 mg/dL. What does the nurse interpret this finding to mean for the patient? A. The protein level is reduced, which is consistent with malnutrition. B. The protein level is normal, and therefore the patient does not have malnutrition. C. The protein level is increased, which is a common finding in patients with cancer. D. The total protein level is increased; the patient would benefit from albumin infusion.

B. Total serum protein level should be between 6.0 and 8.0 g/dL. A protein level of 6.4 is normal. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. pp. 266-267

A patient with cancer who recently had extensive surgical procedures develops hypotension, tachycardia, and decreased urinary output. Which nursing actions would be useful for management of this patient? Select all that apply. A. Discourage fluid intake. B. Administer fibrinolytic agents. C. Replace fluids and electrolytes. D. Administer plasma protein replacement. E. Prepare the patient for radiation therapy.

C, D. Extensive surgical procedures in a cancer patient can lead to third space syndrome, which involves a shift of fluid from the vascular space to the interstitial space. Its management involves replacement of plasma proteins and fluid and electrolytes. The use of fibrinolytic agents further aggravates the patient's condition. Fluid intake should be encouraged, not discouraged. Use of radiation therapy does not prevent the shifting of fluids. p. 263

The patient with cancer is having teletherapy radiation treatments after surgery. What should the nurse teach the patient about the care of the skin? A. Use Dial soap to feel clean and fresh B. Scented lotion can be used on the area C. Avoid heat and cold to the treatment area D. Wear the new bra to comfort and support the area

C. Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing, such as a bra, over the treatment field and will want to expose the area to air as often as possible. p. 255

A patient has been advised to undergo an autologous bone marrow transplant. A nurse explains the procedure to the patient. Which patient statement indicates that the teaching has been understood? A. "It involves transfusing stem cells from an identical twin." B. "It involves transfusing stem cells from a family member." C. "It involves transfusing stem cells harvested from myself." D. "It involves transfusing stem cells from a donor from a bone marrow registry."

C. Bone marrow transplants are very effective in treating malignancies of the bone marrow. There are three types of bone marrow transplantation. An autologous stem cell transplant requires harvesting the stem cells from the patient and transfusing it back to the patient after myeloablative therapy. Syngeneic transplantation involves obtaining stem cells from one identical twin and infusing them into the other. An allogeneic transplantation involves obtaining stem cells from a donor who is human leukocyte antigen (HLA) matched to the patient. It can be a family member or a donor from a bone marrow registry. p. 260

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."

C. Hair loss with radiation usually is permanent. The best response by the nurse is to suggest getting a wig before the patient loses her hair so they will not look or feel so different. When hair grows back after chemotherapy, it is frequently a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss, but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern. p. 256

A nurse discusses chemotherapy treatment with a patient with cancer. Which body system does the nurse tell the patient is most susceptible to the side effects of commonly used antineoplastic drugs? A. Lymphatic B. Respiratory C. Bone marrow D. Cardiovascular

C. One of the most common side effects of chemotherapeutic drugs is bone marrow suppression, which decreases the production of blood cells. Bone marrow is susceptible to chemotherapy because of the rapid cell cycles and replacement of blood-forming tissue in bone marrow. The lymphatic, respiratory, and cardiovascular systems may be affected by chemotherapy drugs but vary in their levels of severity and involvement, whereas bone marrow suppression is common in all forms of antineoplastic therapy. p. 253

The nurse is caring for a patient receiving an initial dose of chemotherapy. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A. Hypokalemia B. Hypouricemia C. Hypocalcemia D. Hypophosphatemia

C. TLS 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 of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia. p. 263

A nurse assesses that a patient undergoing radiotherapy has developed erythema and desquamation. Which should the nurse include when educating the patient about skin care in the radiation treatment area? A. Use perfumes and cosmetics on the treatment area as desired. B. Wear fabrics such as wool and corduroy to prevent exposure to cold. C. Gently cleanse the skin using a mild soap, tepid water, and a soft cloth. D. Allow brief periods of direct exposure to sunlight for good bone health.

C. The skin should be gently cleansed using a mild soap, tepid water, and a soft cloth. Fabrics such as wool and corduroy should not be worn because they can traumatize the skin. Chemicals like perfumes, cosmetics, and powders should not be used on the treatment area because they are harsh on skin and can increase the irritation of the skin. The skin should not be exposed to direct sunlight. Protective clothing should be worn if exposure to sun is expected. p. 251

The nurse is discussing the effects of chemotherapy with a patient who has a new diagnosis of cancer. Which statement by the patient reflects an adequate understanding of the teaching? A. "I will need to use effective birth control methods for the rest of my life." B. "My doctor will stop the chemotherapy if nausea and vomiting occur during treatment." C. "I will join a support group after my therapy is finished to help me get back on my feet." D. "I probably won't be able to do anything I used to do anymore now that I have cancer."

C. The impact of a cancer diagnosis can affect many aspects of a patient's life, with cancer survivors commonly reporting financial, vocational, marital, and emotional concerns even long after treatment is over. These psychosocial effects can play a profound role in a patient's life after cancer, with issues related to living in uncertainty being encountered frequently. Participation in appropriate supportive care and community resources would benefit the patient in recovery or ongoing care. It will not be necessary for the patient to use birth control for the rest of the patient's life; nausea and vomiting are expected effects of chemotherapy and treatment will continue unless the vomiting becomes severe; and though some of the patient's normal activities may be affected, not all will be affected. p. 265

A patient with a long history of psychosis has been diagnosed cancer. What therapeutic methods can the nurse implement to help the patient cope with this diagnosis? A. Help the patient adapt to new lifestyle patterns. B. Show a warm, fuzzy comedy to lighten the mood. C. Listen actively to the patient's fears and concerns. D. Allow the patient to have a party in his or her room.

D. Listening actively to the patient's fears and concerns will best help the patient cope with a new diagnosis. Warm, fuzzy comedies and parties may make the patient feel better for a moment, but this does not facilitate coping with the diagnosis. The patient should maintain usual life style patterns to help with coping; there is no need to change them. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. p. 265

A patient is to undergo radiation therapy. What instruction should the nurse give the patient regarding care of the skin at the site of radiation therapy? A. Expose the area to sunlight twice a week B. Apply an ointment to the area to prevent irritation C. Apply talcum powder to the area to promote comfort D. Wash the area gently with lukewarm water and lightly pat it dry

D. The area undergoing radiation therapy may safely be washed with lukewarm water if it is done gently and if care is taken not to injure the skin. A patient undergoing radiation therapy should avoid anything that may be irritating to the skin, such as sunlight, lotions, ointments, or talcum powder. p. 255

The nurse is caring for a patient with anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

D. The nurse can increase the nutritional density of foods by adding items high in protein or calories (such as peanut butter, skim milk powder, cheese, or honey) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are tolerated best. Supplements can be helpful to promote improved nutritional status so should not be avoided. p. 254

When caring for the patient with cancer, what does the nurse determine is the response of the immune system to antigens of the malignant cells? A. Metastasis B. Tumor angiogenesis C. Immunologic escape D. Immunologic surveillance

D. Immunologic surveillance 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. 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. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance, which allows the cancer cells to reproduce. p. 239