MEDSURG1 Chapter 12: Oncologic Management PREPU
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.
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 receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?
Extravasation
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.
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
The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.
Turkey breast on whole wheat bread Vegetable and cheddar quiche Egg white omelet with spinach and mushrooms
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.
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
A client without symptoms receives a diagnosis of prostate cancer after a routine physical. What factors contributed to this diagnosis? Select all that apply.
tumor markers risk factors client history
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?
Autologous
The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important?
Flush the toilet several times after every use.
Which is a growth-based classification of tumors?
malignancy
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?
Control
The drug interleukin-2 is an example of which type of biologic response modifier?
Cytokine
A client being treated for breast cancer reports pain as being 7 on a scale from 0 to 10. Which type of pain indicates to the nurse that the client is experiencing lymph obstruction from the disease?
Dull, aching, tightness
A decrease in circulating white blood cells is
leukopenia
The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective?
"I will brush my teeth after every meal."
While doing a health history, a client tells the nurse that her mother, her grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse?
"Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level."
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."
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."
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."
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."
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."
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."
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."
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
A client is undergoing chemotherapy treatment for prostate cancer and has lost considerable weight due to nausea and vomiting. Which nursing intervention is appropriate for the client?
Adjusting the client's meal plan before and after chemotherapy
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?
Administering metoclopramide and dexamethasone as ordered
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?
Allogeneic
5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?
Antimetabolite
Which of the following is a term used to describe the process of programmed cell death?
Apoptosis
The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action?
Avoiding the use of products containing aspirin
Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure?
Blood studies
A client diagnosed with cancer makes the following statement to the nurse: "I guess I will tell my health care provider to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die." Which of the following facts supports the use of chemotherapy for this client?
Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects.
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
While administering cisplatin to a client, the nurse assesses swelling at the insertion site. What is the nurse's first action?
Discontinue the intravenous medication
An oncology nurse is caring for a client who relates that certain tastes have changed. The client states that "meat tastes bad." What nursing intervention can be used to increase protein intake for a client with taste changes?
Encourage eating cheese, eggs, and legumes
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.
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
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. Visitors may stay for 30 minutes or less.
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
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.
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
Which of the following is a characteristic of a malignant tumor?
It gains access to the blood and lymphatic channels.
A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?
Liver
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.
A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend?
Oranges
Which type of surgery is used in an attempt to relieve complications of cancer?
Palliative
You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer?
Prophylactic surgery
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.
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?
Serum potassium level of 2.6 mEq/L
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?
Stage 3 pressure ulcer on the left heel
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
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.
A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because:
The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.
Which of the following would be consistent with a benign neoplasm?
Usually progressive and slow
Which of the following would be inconsistent as a common side effect of chemotherapy?
Weight gain
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include:
chemotherapy exposure and risk factors.
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
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. Check intake and output records. Apply pressure to the bleeding sites.
The nurse is caring for a client with cancer who is treating her cancer with deep-tissue massage in addition to radiation therapy. The nurse documents the use of which therapy on the client's chart?
Integrative medicine
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.
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
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