Chapter 15 : Management of of Patients with Oncologic Disorders

During a client's examination and consultation, the physician keeps telling the client,"You have an abdominal neoplasm." Which statements accurately paraphrase the physician's statement? Select all that apply.

"You have a new growth of abnormal tissue in your abdomen." "You have an abdominal tumor." New growths of abnormal tissue are called "tumors." Tumors may be benign or malignant; not all tumors are cancerous.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

Administering metoclopramide and dexamethasone as ordered The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?

Antimetabolite 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR).

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan?

Avoiding using soap on the irradiated areas Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.

A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment?

Cancer of the bladder Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer.

The nurse should teach the patient who is being radiated about protecting his skin and oral mucosa. An important teaching point would be to tell the patient to:

Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. The patient should cleanse himself with a mild soap using his fingertips rather than a wash cloth. All the other choices will irritate the skin and fail to protect it from additional injury.

A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation?

Closely monitor the client for at least 3 months. After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?

Control 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.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?

Encourage fluid intake to dilute the urine. The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage.

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:

Encourage fluid intake, if possible, to dilute the urine. To prevent renal damage, it is helpful to dilute the urine by increasing fluids as tolerated.

A patient with uterine cancer is being treated with intracavitary radiation. The patient will emit radiation while the implant is in place. The nurse is aware of the precautions necessary for the provider of care and visitors. Which of the following are appropriate guidelines to follow? Select all that apply.

Family members should stand about 6 feet from the patient. Lead aprons should be worn to buffer the exposure. Visitors may stay for 30 minutes or less. Exposure for the nurse, health care provider or visitors should be limited to 30 minutes/8-hour shift. As time increases, exposure to radiation increases. The goal is to deliver safe, efficient care in the shortest amount of time.

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. 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.

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?

Prophylactic 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.

A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis?

Red, open sores on the oral mucosa The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority?

Risk for infection Risk for infection takes highest priority in clients with severe bone marrow depression because they have a decrease in the number of white blood cells, the cells that fight infection. Making clients aware that they are at risk for injuries can help prevent such injuries as falls. The nurse should institute the facility's falls prevention protocol and supply assistive devices, such as a walker, cane, or wheelchair, when needed. Imbalanced nutrition: Less than body requirements is also of concern but doesn't take priority over preventing infection. Anxiety is likely present in clients with severe bone marrow depression; however, anxiety doesn't take priority over preventing infection.

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 Physiological needs, such as risk for infection, take priority over the client's other needs.

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?

Shorten the period of neutropenia Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.

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 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 nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?

The I.V. site is red and swollen. A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time.

Which statement is true about malignant tumors?

They gain access to the blood and lymphatic channels. 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.

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?

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 client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?

Tumor pressure against normal tissues 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?

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.

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy?

fever The effects of chemotherapy two weeks after treatment can result in a fever. Regrowth of hair after alopecia can result in change of hair color, but this effect is not anticipated 2 weeks after treatment. White blood cell count will be decreased 2 weeks after chemotherapy. Constipation is not usually seen 2 weeks after chemotherapy treatment.

Palliation refers to

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.

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with

seizures 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.

The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse?

"I can continue taking my vitamins and herbs because they make me feel better." Herbal products are not regulated by the U.S. Food and Drug Administration (FDA);although some can decrease the risk of cancer, others can have serious side effects and liver toxicity. Use of vitamins and herbals should be reviewed with the oncologist. Use of clear liquids is recommended for the client experiencing nausea and vomiting. Because hair follicles are sensitive to chemotherapy drugs, it is likely for alopecia to occur especially with consecutive treatments. Chemotherapy includes cytotoxic drugs that are harmful to rapid dividing cells such as cell development in the fetus. To prevent damage to the fetus, birth control is recommended during treatment.

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 clean my teeth gently several times per day." 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 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.

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 client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit?

"I'll play card games with my friends." During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions.

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." 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 will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse?

"It will allow time for the repair of healthy tissue." In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death.

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." 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 lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue?

95% The radiation dosage is dependent on the sensitivity of the target tissues to radiation and on the tumor size. The lethal tumor dose is defined as the dose that will eradicate 95% of the tumor yet preserve normal tissue.

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. 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 life-style. They also may express anger related to the diagnosis and their inability to be in control. While depression is a psychiatric diagnosis not everyone has the diagnosis sometime in their life; depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.

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.

Which class of antineoplastic agents is cell cycle-specific?

Antimetabolites (5-FU) Antimetabolites are cell cycle-specific (S phase). Antitumor antibiotics, alkylating agents, and nitrosoureas are cell cycle-nonspecific.

A client with cancer is receiving chemotherapy and reports to the nurse that his or her mouth is painful and has difficulty ingesting food. What actions should the nurse take? Select all that apply.

Asks the client to open his or her mouth to facilitate inspection of the oral mucosa Instructs the client to brush the teeth with a soft toothbrush Consults with the healthcare provider about use of nystatin The description of the client's report is stomatitis following chemotherapy treatment. The nurse should assess the oral mucosa based on the client's report of pain and difficulty eating. The client is to use a soft toothbrush to minimize trauma to the mouth. Nystatin (Mycostatin) is a topical medication that may provide healing for the client's mouth. The client avoids alcohol-based mouthwashes as these are irritants. Flossing the teeth may cause additional trauma to the mouth.

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?

Blood studies Before the BMT 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 a BMT procedure, the nurse need not evaluate the client's family, drug, or allergy history.

Which of the following is a type of procedure that uses liquid nitrogen to freeze tissue and cause cell destruction?

Cryosurgery Cryosurgery uses liquid nitrogen or a very cold probe to freeze tissue to cause cell destruction. Electrosurgery, chemosurgery, and laser surgery do not use liquid nitrogen to freeze tissue.

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?

Excisional biopsy Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.

The nurse is teaching a healthy lifestyle class to a group of adolescents. The nurse recommends

Exercising at least 60 minutes per day doing moderate to vigorous activities at least 5 days per week The American Cancer Society recommendations are for adolescents to engage in at least 60 minutes of moderate to vigorous physical activity at least 5 days per week. The MyPyramid recommendations include 4 1/2 cups of fruits and vegetables every day. People who have a body mass index less than 24 are at increased risk for problems associated with poor nutritional status. Ingesting more protein will not necessarily build more muscle mass and is not recommended for normal healthy individuals.

You are the nurse caring for a client with cancer. The client complains of pain and nausea. When assessed, you note that the client appears fearful. What other factor must you consider when a client with cancer indicates signs of pain, nausea, and fear?

Fatigue Clients with cancer experience fatigue, which is a side effect of cancer treatments that rest fails to relieve. The nurse must assess the client for other stressors that contribute to fatigue such as pain, nausea, fear, and lack of adequate support. The nurse works with other healthcare team members to treat the client's fatigue. The above indications do not contribute to infections, ulcerations, or high cholesterol levels.

The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important?

Flush the toilet twice after every use. Iodine 131 is a systemic internal radiation that is excreted through body fluids, especially urine. Flushing the toilet twice after every use will avoid the exposure of others to radioactive exposure. Shielding the throat area is not effective because this form of treatment is systemic. Preparing food separately is not necessary, but use of separate eating utensils will be necessary for the first 8 days.

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:

Increase her intake of calcium-rich foods. One of the major side effects of Aromasin is hypercalcemia and the subsequent loss of bone. Therefore, the patient needs to have periodic blood work done, have bone density tests done, and follow a diet that will supply needed calcium that is being pulled from the bone tissue.

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.

The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic?

Slow rate of growth Benign tumors have a slow rate of growth and well-differentiated cells. Benign tumors do not invade surrounding tissue and do not cause generalized symptoms unless the location of the tumor interferes with the functioning of vital organs.

What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss?

The client should consider getting a wig or cap prior to beginning treatment. 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.

To combat the most common adverse effects of chemotherapy, a nurse should administer an:

antiemetic. Antiemetics, antihistamines, and certain steroids treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

A client without symptoms receives a diagnosis of prostate cancer after a routine physical. What factors contributed to this diagnosis? Select all that apply.

client history risk factors tumor markers The health care provider, using information obtained during the history and physical examination, selects tests that help to establish a diagnosis. Specific cancers alter the chemical composition of blood and other body fluids. Specialized tests have been developed for specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The use of sunscreen would be part of a skin cancer diagnosis.

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?

prophylactic 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.

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." 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 client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed?

"I guess the doctor could not remove the entire tumor." Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.

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." 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 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." 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 nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching?

7 to 14 days Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.

A patient, age 67 years, is admitted for diagnostic studies to rule out cancer. The patient is Caucasian, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? (Select all that apply.)

Age Cigarette smoking Occupation Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in African American men remain substantially higher than those among Caucasian men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans (Fontham et al., 2009). Smoking is strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia. Marital status is not associated with risk for cancer.

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 The hallmarks of hereditary cancer syndrome include cancer in two or more first-degree or second-degree relatives, early onset of cancer in family members younger than age 50, the same type of cancer in several family members, individual family members with more than one type of cancer, and a rare cancer in one or more family members.

A client has been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions: (Select all that apply.)

Assess level of consciousness. Apply pressure to the bleeding sites. Check intake and output records. The client may be experiencing disseminated intravascular coagulation (DIC) following the cancer experience and chemotherapy treatment. When the nurse notes the client is experiencing unexpected and abnormal bleeding, the nurse will assess level of consciousness (the client can be bleeding in the brain) and intake and output records (the client may experience decreased urinary output as a result of poor renal perfusion). The nurse applies pressure to venipuncture sites to decrease bleeding. The nurse will assess vital signs more frequently than once a shift. The nurse minimizes client activities to decrease risk for injury.

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?

Closely observe the client's skin for petechiae and bruising. The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.

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?

Colonoscopy 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.

The drug interleukin-2 is an example of which type of biologic response modifier?

Cytokine Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.

A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient?

Explain to the patient that she will continue to emit radiation while the implant is in place. When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source.

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?

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.

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?

Extravasation The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.

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?

Fear Fear of the unknown is probably the major concern for this client. 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. Ineffective Coping can be illustrated by the client's refusal to talk about the problem, but no excess or abnormal behavior has been identified at this time.

In which phase of the cell cycle does RNA and protein synthesis occur?

G1 phase RNA and protein synthesis occur in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase. Cell division occurs in mitosis.

Which grade of tumor is also known as a well-differentiated tumor?

Grade I Grade I tumors, also known as well-differentiated tumors, closely resemble the tissue of origin in structure and function. In grade II, the tumor is moderately differentiated. Tumors in grade III are poorly differentiated (little resemblance to tissue of origin). Grade IV tumors is undifferentiated (unable to tell tissue of origin).

Chemotherapeutic agents have which effect associated with the renal system?

Increased uric acid excretion Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Urinary excretion of uric acid increases with the use of chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.

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?

Inspect the skin frequently. Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.

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 lowers serum and uric acid levels. The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurence 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.

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 removes a wedge of tissue for diagnosis. 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.

A decrease in circulating white blood cells (WBCs) is referred to as

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.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?

Liver The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.

A client has received several treatments of bleomycin. It is now important for the nurse to assess

Lung sounds Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.

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 A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.

In which phase of the cell cycle does cell division occur?

Mitosis 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.

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client?

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.

A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend?

Oranges A diet high in vitamin C and citrus may help reduce the risk of certain cancers, such as stomach and esophageal cancers. Hot dogs and smoked and cured foods are high in nitrates, which may be linked to esophageal and gastric cancers. Steak is a high-fat food that may increase the risk of breast, colon, and prostate cancers.

Which type of surgery is used in an attempt to relieve complications of cancer?

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.

Which of the following is generally NOT considered to be a carcinogen?

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?

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.

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?

Provide time for the patient to discuss her concerns. Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery. The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse's response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another.

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 a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote.

A nurse is administering a peripheral chemotherapeutic agent. What nursing actions are used for extravasation of a chemotherapeutic agent? Select all that apply.

Stop the medication infusion at the first sign of extravasation Aspirate any residual drug from the IV line Administer an antidote, if indicated All of the answers except application of a warm compress are appropriate nursing actions. The application of warmth would be contraindicated because it would cause vasodilation, which would increase the absorption of irritant into the local tissues. Short term chemotherapy can be done with peripheral catheters so the client may not need an implanted device.

A client asks the nurse what is causing the fatigue following radiotherapy. What is the nurse's best response?

Substances are released when tumor cells are destroyed. Fatigue results from substances being released when tumor cells are destroyed during radiotherapy. The spreading of cancer can cause many symptoms dependent on location and type of cancer, but it is not a significant factor in the development of fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support the presence of infection in this client.

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?

Sun safety and use of sunscreen 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.

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 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.

What is the best way for the nurse to assess the nutritional status of a patient with cancer?

Weigh the patient daily. Assessment of the patient's nutritional status is conducted at diagnosis and monitored throughout the course of treatment and follow-up. Early identification of patients at risk for problems with intake, absorption, and cachexia, particularly during the early stages of disease, can facilitate timely implementation of specifically targeted interventions that attempt to improve quality of life, treatment outcomes, and survival. Current weight, weight loss, diet and medication history, patterns of anorexia, nausea and vomiting, and situations and foods that aggravate or relieve symptoms are assessed and addressed.

The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is:

cell-cycle nonspecific. Antitumor antibiotics are cell-cycle nonspecific; they interfere with deoxyribonucleic acid (DNA) synthesis by binding with the DNA. They also prevent ribonucleic acid synthesis. Other cell-cycle nonspecific drugs include nitrosoureas and hormonal agents. Drugs that are cell-cycle specific in the S phase include topoisomerase I inhibitors and antimetabolites. Miotic spindle poisons are cell-cycle specific in the M phase. There isn't a drug class that's specific to the P phase.

Carcinogens are factors related to the formation of various malignancies. Which factor has the greatest impact on the development of all cancers?

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.

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.

dietary substances environmental factors viruses Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice?

eats red meat such as steaks or hamburgers every day Dietary substances such as nitrate-containing and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. Alcohol consumption recommendations include drink no more than one drink per day for women or two per day for men.

The nurse is working with a client who has had an allohematopoietic 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

graft-versus-host disease. 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.

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:

inhalation of aerosols. Aerosol inhalation or absorption through the skin can cause accidental chemotherapy exposure. A nurse must wear a disposable gown and gloves when preparing and administering chemotherapy. She won't absorb chemicals through an intact gown, protective gloves, or goggles.

Cancer is the second leading cause of death in the United States, second only to heart disease. Half of all men and one third of all women will develop cancer during their lifetimes. Which types of cancer have the highest prevalence among both men and women?

lung and colon Common cancers in men include prostate, lung, and colon. Breast, lung, and colon cancer most commonly affect women.

When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply.

muscle weakness cramps and spasms in the legs loss of balance and coordination Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.

A client with a recent history of GI disturbance has been scheduled for a barium study. The physician ordered this particular test for this client because it will:

show movement of the GI tract. A barium study is an example of fluoroscopy, which is used to show continuous x-ray images on a monitor, allowing the movement of a body structure to be viewed. Fluoroscopy does not involve the biopsy of tissue samples. Nuclear imaging, not a barium study, uses IV tracers to reveal tumor hot spots. CT scans provide three-dimensional cross-sectional views of tissues to determine tumor density, shape, size, volume, and location as well as highlighting blood vessels that feed the tumor.

An oncology nurse is caring for a client who is taking antineoplastic agents. What symptoms would the nurse consider with tumor lysis syndrome when monitoring this client?

symptoms of gout The nurse monitors the client being administered an antineoplastic agent for symptoms of gout, which include increased uric acid levels, joint pain, and edema, with the consideration of tumor lysis syndrome. Administering antineoplastic agents does not cause hypertension, constipation, or anemia.