Oncology

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

Constipation following initial diarrhea/vomiting

An oncology nurse educator is providing health education to a client who has been diagnosed with skin cancer. The client's wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite?

Malignant cells possess greater mobility

What does the HPV vaccine protect against?

cervical cancer

A client with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location rules out the use of enteral feeding. What intervention will best meet this client's nutritional needs?

parenteral nutrition through PICC

1. What factors may be responsible for R.M.'s decreased WBC and neutrophil count? 2. What assessment data indicate that R.M. may have an infection? 3. What additional assessment data should be collected from R.M. to determine the presence of an infection? 4. Patient-Centered Care: What factors may contribute to his negative attitude toward the chemotherapy? 5. Priority Decision: What are the priority nursing measures that should be used to help control his anorexia, nausea, and vomiting? 6. His daughter is visiting and wants to know how the cancer metastasized to his lung. What should the nurse teach her about metastasis? 7. During her visit, R.M.'s daughter questions how likely she is to get cancer. What should the nurse explain to her about risk factors and screening tests? 8. Priority Decision: What are the priority teaching measures that should be included in the teaching plan for R.M. and his family to prevent infection? 9. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

1. Chemotherapy-induced bone marrow suppression is the most relevant factor in the patient's decreased white blood cell (WBC) and neutrophil count. Inadequate protein intake would also contribute to impaired recovery of normal blood cells. 2. A temperature of 99.7° F (37.4° C) in an immunosuppressed patient is a significant finding for infection. He also has warm skin, with some degree of dehydration, and says he feels hot. His risk of infection is high, with a WBC count of 3200/μL and neutrophils of 500/μL. The risk for infection increases when neutrophils are < 1000/μL. 3. Assess for sore throat, mouth sores or blisters, chest pain, persistent cough, urinary symptoms, skin lesions, rectal pain, or confusion. Note the catheter site for chemotherapy as a possible source of infection. 4. His nausea, vomiting, and anorexia as well as not feeling well from any other side effects of chemotherapy may contribute to his negative attitude. Negative attitude may also be promoted by lack of social support, an inability to cope with stress, an inability to express his feelings and concerns, the lack of control he may be feeling, a past negative experience with cancer in a friend, and lack of information about expected results of treatment. 5. Nursing measures • Use antiemetic protocols to control treatment-related nausea and vomiting. • Offer small, frequent feedings of bland, high-calorie, high-protein foods (e.g., milk shake, eggnog, cottage cheese) in a pleasant environment. • Provide or encourage frequent oral care. • Use relaxation techniques and distraction when the patient is nauseated. • Offer any fluids, supplements, or foods that the patient can tolerate and that may be appealing to him. • Avoid nagging or being judgmental about food intake. • Keep a food diary to track daily calories and fluids. 6. Metastasis can occur when cancer cells detach from the primary tumor to invade tissue surrounding the tumor. Via tumor angiogenesis, hematogenous metastasis can occur through the vascular or lymphatic circulation. 7. There is a lesser incidence of lung cancer in black women than men but a high morbidity. Less cancer is seen with avoidance of exposure to carcinogens (e.g., limited alcohol use, no tobacco use, limited sun exposure), regular physical activity, maintaining a normal body weight, reducing fat consumption, increasing fruit and vegetable consumption, and regular physical examinations. There are no specific screening tests for lung cancer, but the 7 warning signs of cancer include change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge from any body orifice, thickening or a lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and nagging cough or hoarseness. The routine screenings that are done to detect cancer include colorectal screening, breast selfexamination, clinical breast examination, mammogram, and Papanicolaou (Pap) tests. 8. Teaching measures • Hand washing with antibacterial soap for staff, patient, and visitors • Do not scratch skin or use a razor with a blade • Careful sterile technique in caring for IV catheter site • Avoidance of visitors with infection • Wear shoes to prevent cuts • Use a soft toothbrush to prevent cuts in the mouth • Report any manifestations of infection 9. Nursing diagnoses • Lack of knowledge; Etiology: insufficient knowledge about cancer and treatment • Impaired nutritional status; Etiology: decreased oral intake, increased metabolic demands of cancer • Fluid imbalance; Etiology: decreased oral fluid intake • Risk for infection; Etiology: immunosuppression • Hyperthermia; Etiology: likely infection • Difficulty coping; Etiology: cancer metastasis Collaborative problems Potential complications: septicemia, negative nitrogen balance, myelosuppression

1. The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse emphasizes what as the most important preventive action for both women and men? a. Smoking cessation b. Routine colonoscopies c. Frequent imaging tests d. Regular examination of reproductive organs

1. a. Lung cancer is the leading cause of cancer deaths in the United States for both women and men. Smoking cessation is one of the most important cancer prevention behaviors. About ½ of cancer-related deaths in the United States are related to tobacco use, unhealthy diet, physical inactivity, and obesity. Cancer of the breast and prostate are the second leading causes of cancer deaths, and colon cancer is the third.

4. What factor differentiates a malignant tumor from a benign tumor? a. It causes death. b. It grows at a faster rate. c. It is often encapsulated. d. It invades and metastasizes.

4. d. The major difference between malignant and benign cells is the ability of malignant tumor cells to invade and metastasize. Benign tumors can cause death by expansion into normal tissues and organs. Benign tumors are more often encapsulated and often grow at the same rate as malignant tumors.

Cancer CAUTION

C - change in bowel/bladder A - sore won't heal U - unusual bleeding T - thickening/lump I - indigestion O - obvious change wart/mole N - nagging cough/hoarseness Unexplained weight loss, fatigue, night pain

5.An exploratory laparotomy is performed on a client with melena, and gastric cancer is discovered. A partial gastrectomy is performed, and a jejunostomy tube is surgically implanted. A nasogastric tube to suction is in place. What should the nurse expect regarding the client's nasogastric tube drainage during the first 24 hours after surgery? 1 Minimal to no drainage Correct2 Contains some blood and clots 3 Contains large amounts of frank blood 4 Similar to coffee grounds in color and consistency

Containing some blood and clots is an expected response during the first 24 hours after a gastric resection because of oozing of blood and blood coagulation. There will be a moderate amount of drainage, not minimal or no drainage. Green and viscid are normal characteristics of gastric contents, which are unexpected after gastric surgery. Containing large amounts of frank blood indicates hemorrhage, which is unexpected. Coffee ground material results from blood that has been digested by the gastric acid; gastric bleeding with a nasogastric tube in place will be red because gastric acids will not have time to act on the blood.

A nurse obtains the history of a client with early colon cancer. Which clinical finding does the nurse consider consistent with a diagnosis of cancer of the descending, rather than the ascending, colon? 1 Pain 2 Fatigue 3 Anemia Correct4 Obstruction

Obstruction Signs and symptoms of obstruction occur earlier with cancer in the descending colon because the consistency of the stool is formed rather than liquid. Pain, a late symptom of colon cancer, may occur regardless of the location of the primary lesion. Fatigue occurs in colon cancer regardless of the primary site; it is related to anorexia, weight loss, and anemia. Bleeding, which results in anemia, occurs in colon cancer regardless of the primary site because the lesions extend into the intestinal mucosa.

A client with a diagnosis of gastric cancer has a gastric resection with a vagotomy. Which clinical response should alert the nurse that the client is experiencing dumping syndrome? 1 Constipation 2 Clay-colored stools 3 Sensations of hunger Correct4 Reactive hypoglycemia

Rapid gastric emptying that occurs after a gastric resection causes rapid elevation of blood glucose followed by increased insulin secretion, resulting in reactive hypoglycemia and dumping syndrome. Diarrhea, not constipation, occurs. Steatorrhea (fat), not clay-colored stools, may occur. Anorexia, not sensations of hunger, occurs

Staging of Cancer TNM

T: tumor N: nodes M: metastasis

best way to assess nutritional status of pt with cancer?

daily weights

carcinogens (& examples)

genes, radiation, virus, cigarettes, hormones, food additives, pollution

22. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a. IL-2 enhances the immunologic response to tumor cells. b. IL-2 stimulates malignant cells in the resting phase to enter mitosis. c. IL-2 prevents the bone marrow depression caused by chemotherapy. d. IL-2 protects normal cells from the harmful effects of chemotherapy.

ANS: A IL-2 enhances the ability of the patients own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression.

A client returns to the surgeon's office for a report on a diagnostic procedure to determine the cell composition of the client's abdominal neoplasm. Which term is significant to indicate the likelihood of the tumor spreading?

Benign - Don't Spread Malignant - Likely to spread

The nurse is providing care for a client diagnosed with invasive pancreatic cancer. The client has a permanent biliary drainage tube (T-tube) inserted to provide palliative care. Which action should the nurse take postoperatively? 1 Maintain intermittent low suction to limit trauma. Correct2 Cleanse the area around the insertion site to prevent skin breakdown. 3 Attach the tube to a negative-pressure drainage system to promote drainage.

Bile is irritating to the skin; cleansing the area around the T-tube to prevent skin breakdown is a priority. Suction is contraindicated; drainage is via gravity. The T-tube is attached to a bag for straight drainage via gravity, not suction that uses negative pressure. Repositioning the client is vital to prevent venous and pulmonary stasis, not for facilitating the drainage of bile

A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching?

most of the side effects from radiation will ease after treatment (side effects actually last up to 6-12 months)

39. The 85-year-old male client diagnosed with cancer of the colon asks the nurse, "Why did I get this cancer?" Which statement is the nurse's best response? 1. "Research shows a lack of fiber in the diet can cause colon cancer." 2. "It is not common to get colon cancer at your age; it is usually in young people." 3. "No one knows why anyone gets cancer, it just happens to certain people." 4. "Women usually get colon cancer more often than men but not always."

. A long history of low-fiber, high-fat, and high-protein diets results in a prolonged transit time. This allows the carcinogenic agents in the waste products to have a greater exposure to the lumen of the colon.

8. The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. After cancer has not recurred for 5 years, it is considered cured. b. The cancer will be cured if the entire tumor is surgically removed. c. Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation. d. I will need to have follow-up examinations for many years after I have treatment before I can be considered cured.

ANS: D The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

8. A patient was told she has carcinoma in situ, and the student nurse wonders what that is. How should the nurse explain this to the student nurse? a. Evasion of the immune system by cancer cells b. Lesion with histologic features of cancer except invasion c. Capable of causing cellular alterations associated with cancer d. Tumor cell surface antigens that stimulate an immune response

8. b. Carcinoma in situ has the histologic features of cancer except invasion. Evasion of the immune system by cancer cells by various methods is immunologic escape. Oncogenic factors can cause cellular alterations associated with cancer. Tumor cell surface antigens that stimulate an immune response are tumor-associated antigens.

3. What does the presence of carcinoembryonic antigens (CEAs) and αfetoprotein (AFP) on cell membranes show has happened to the cells? a. They have shifted to more immature metabolic pathways and functions. b. They have spread from areas of original development to different body tissues. c. They produce abnormal toxins or chemicals that show abnormal cellular function. d. They have become more differentiated because of repression of embryonic functions.

3. a. Cancer cells become more fetal and embryonic (undifferentiated) in appearance and function and some produce new proteins, such as carcinoembryonic antigen (CEA) and α-fetoprotein (AFP), on cell membranes that reflect a return to more immature functioning. The other options are unrelated to CEA and AFP.

30. Priority Decision: During initial chemotherapy, a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be to a. increase urine output with hydration therapy. b. establish electrocardiographic (ECG) monitoring. c. administer a bisphosphonate, such as pamidronate (Aredia). d. restrict fluids and administer hypertonic sodium chloride solution

30. a. Hyperkalemia and hyperuricemia are characteristic of tumor lysis syndrome, which is the result of rapid destruction of large numbers of tumor cells. Signs include hyperuricemia that causes acute kidney injury, hyperkalemia, hyperphosphatemia, and hypocalcemia. To prevent renal failure and other problems, the primary treatment includes increasing urine production using hydration therapy and decreasing uric acid concentrations using allopurinol (Zyloprim). Electrocardiogram (ECG) monitoring is important with hyperkalemia, but the priority is to increase urine output. Administering a bisphosphonate is for hypercalcemia

5. A patient is admitted with acute myelogenous leukemia and a history of Hodgkin's lymphoma. What is the nurse most likely to find in the patient's history? a. Work as a radiation chemist b. Epstein-Barr virus diagnosed in vitro c. Intense tanning throughout the lifetime d. Alkylating agents for treating the Hodgkin's lymphoma

5. d. Alkylating agents are used to treat Hodgkin's lymphoma and are carcinogens associated with initiation of acute myelogenous leukemia. ' Working with radiation would lead to a higher incidence of bone cancer. Epstein-Barr virus is seen in vitro with Burkitt's lymphoma. Intense tanning or exposure to ultraviolet radiation is associated with skin cancers.

7. Cancer cells go through stages of development. What accurately describes the stage of promotion (select all that apply)? a. Obesity is an example of a promoting factor. b. The stage is characterized by increased growth rate and metastasis. c. Withdrawal of promoting factors will reduce the risk of cancer development. d. Tobacco smoke is a complete carcinogen that is capable of both initiation and promotion. e. Promotion is the stage of cancer development in which there is an irreversible alteration in the cell's DNA.

7. a, c, d. Promoting factors, such as obesity and tobacco smoke promote cancer in the promotion stage of cancer development. Eliminating risk factors can reduce the chance of cancer development as the activity of promoters is reversible in this stage. Increased growth, invasion, and metastasis are seen in the progressive stage

A nurse is teaching a group of adults about the signs and symptoms of colorectal cancer. Which common clinical manifestations should the nurse include in the teaching program? Select all that apply. Correct1 Anemia 2 Rectal pain Correct3 Rectal bleeding Correct4 Change in bowel habits 5 Severe abdominal distention

The most common signs are anemia, rectal bleeding, and a change in stool consistency or shape or change in bowel habits. Abdominal, not rectal, pain can occur. Severe abdominal distention does not occur.

A client with esophageal cancer is to receive total parenteral nutrition. A right subclavian catheter is inserted. What is the primary reason total parenteral nutrition is infused through a central line rather than a peripheral line? 1 It prevents the development of infection. 2 There is less chance of this infusion infiltrating. 3 It is more convenient so clients can use their hands. Correct4 The large amount of blood helps dilute the concentrated solution

Unless diluted by the increased blood flow, the highly concentrated solution can cause injury to the veins. The potential of infection is high with parenteral nutrition because of the increased glucose levels. The other options are not the primary reason, although the infusion at this site is more secure and promotes free use of the arms and hands

19. For which type of malignancy should the nurse expect the use of the intravesical route of regional chemotherapy delivery? a. Bladder b. Leukemia c. Osteogenic sarcoma d. Metastasis to the brain

a. Intravesical regional chemotherapy is administered into the bladder via a urinary catheter. Leukemia is treated with IV chemotherapy. Osteogenic sarcoma is treated with intraarterial chemotherapy via vessels supplying the tumor. Metastasis to the brain is treated with intraventricular or intrathecal chemotherapy via an Ommaya reservoir or lumbar punctures.

tumor lysis syndrome

can develop from chemotherapy for cancers with rapid cell turnover. It is characterized by hyperphosphatemia, hyocalcemia, hyperkalemia (EKG changes), and hyperuricemia. Prevention of tumor lysisi syndrome invovles hydration and the use of hypouricemic agents such as allopurinol or rasburicase

cancers with highest prevalence in both men and women?

lung and colon

The nurse should teach the patient who is being radiated about protecting his skin and oral mucosa. What is an important teaching point to include?

mild soap and water

Which of the following does a nurse have to assess during the bone marrow transplant (BMT) procedure?

psychological status

what contributes to the diagnosis of prostate cancer?

risk factors, client history, tumor markers

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

-Small rapid tumors that are well oxygenated are more susceptible -slow growing tissue does not respond well

Which complaint is significant for the nurse to assess in the adolescent male client who uses oral tobacco? 1. The client complains of clear to white sputum. 2. The client has an episodic blister on the upper lip. 3. The client complains of a nonhealing sore in the mouth. 4. The client has bilateral ducts at the second molars

1. Clear to white sputum is not significant in the client using oral tobacco. 2. Episodic blisters on the lips are herpes simplex 1 and are not specific to this client. 3. Presence of any nonhealing sore on the lips or mouth may be oral cancer. Oral cancer risk increases by using oral tobacco. 4. Bilateral Stensen's ducts visible at the site of the second molars are normal assessment data.

50. The client has undergone an abdominal perineal resection of the colon for colon cancer with a left lower quadrant colostomy. Which interventions should the nurse implement? Select all that apply. 1. Assess the stoma for color every four (4) hours and prn. 2. Encourage the client to turn, cough, and deep breathe every two (2) hours. 3. Maintain the head of the bed 30 to 40 degrees elevated at all times. 4. Auscultate for bowel sounds every four (4) hours. 5. Administer pain medications sparingly to prevent addiction

1. The colostomy stoma should be assessed to determine circulation to the stoma at least every four (4) hours. A purple or bluish purple indicates that the circulation to the stoma is impaired and is a medical emergency. 2. This is an extensive surgery requiring the client to be under general anesthesia for several hours. Turning, coughing, and deep-breathing exercises done at least every two (2) hours helps to prevent pneumonia. 633 3. The client is not allowed to sit on the perineal area for several days and should be maintained in a side-lying position when possible. 4. The nurse should assess for bowel activity at regularly scheduled intervals. 5. Pain medication is administered to control the client's pain; the nurse is concerned with client comfort, not addiction. Poorly controlled pain is more likely to result in drugseeking behavior than adequately treated pain.

11. A patient's breast tumor originates from embryonal ectoderm. It has moderate dysplasia and moderately differentiated cells. It is a small tumor with minimal lymph node involvement and no metastases. What is the best description of this tumor? a. Sarcoma, grade II, T3N4M0 b. Leukemia, grade I, T1N2M1 c. Carcinoma, grade II, T1N1M0 d. Lymphoma, grade III, T1N0M0

11. c. The breast cancer origination gives it the anatomic classification of a carcinoma. Grade II has moderate abnormal cells with moderate differentiation. T1N1M0 represents a small tumor with only minimal regional spread to the lymph nodes and no metastasis. Sarcomas originate from embryonal mesoderm or connective tissue, muscle, bone, and fat. Leukemias and lymphomas originate from the hematopoietic system. The other histologic grading and TNM classifications do not represent this patient's tumor.

16. Which condition would be most likely to be cured with chemotherapy as a treatment measure? a. Neuroblastoma b. Small cell lung cancer c. Small tumor of the bone d. Large hepatocellular carcinoma

16. a. Neuroblastomas are cured with chemotherapy. A positive response of cancer cells to chemotherapy is most likely in solid or hematopoietic tumors that arise from tissue that has a rapid rate of cellular proliferation and new tumors with cells that are rapidly dividing. A state of optimum health and a positive attitude of the patient will also promote the success of chemotherapy.

18. The nurse uses many precautions during IV administration of vesicant chemotherapy agents primarily to prevent a. septicemia. b. extravasation. c. catheter occlusion. d. anaphylactic shock.

18. b. One of the major concerns with the IV administration of vesicant chemotherapy agents is infiltration or extravasation of drugs into tissue surrounding the infusion site. When infiltrated into the skin, vesicants cause pain, severe local tissue breakdown, and necrosis. Specific measures to ensure adequate dilution, patency, and early detection of extravasation and treatment are important. The other options are not related to the administration of vesicants.

2. What defect in cellular proliferation is involved in the development of cancer? a. A rate of cell proliferation that is more rapid than that of normal body cells b. Shortened phases of cell life cycles with occasional skipping of G1 or S phases c. Rearrangement of stem cell RNA that causes abnormal cellular protein synthesis d. Indiscriminate and continuous proliferation of cells with loss of contact inhibition

2. d. Malignant cells proliferate indiscriminately and continuously and lose the characteristic of contact inhibition, growing on top of and in between normal cells. Cancer cells usually do not proliferate at a faster rate than normal cells, nor can cell cycles be skipped in proliferation. However, malignant proliferation is continuous, unlike normal cells

20. Which delivery system would be used to deliver regional chemotherapy for metastasis from a primary colorectal cancer? a. Intrathecal b. Intraarterial c. Intravenous d. Intraperitoneal

20. d. Intraperitoneal regional chemotherapy administration is used to treat metastasis from a primary colorectal cancer. Intrathecal administration is used with the spinal cord or the brain. Intraarterial administration is used to deliver chemotherapy to tumors via specific vessels. IV administration is used for systemic administration

24. Priority Decision: When a patient is undergoing brachytherapy, what is it important for the nurse to be aware of when caring for this patient? a. The patient will undergo simulation to identify and mark the field of treatment. b. The patient is a source of radiation, and personnel must wear film badges during care. c. The goal of this treatment is only palliative, and the patient should be aware of the expected outcome. d. Computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue.

24. b. Brachytherapy is the implantation or insertion of radioactive materials directly into the tumor or in proximity to the tumor and may be curative. The patient is a source of radiation. In addition to implementing the principles of time, distance, and shielding, caregivers should wear film badges to monitor the amount of radiation exposure. Computerized dosimetry and simulation are used in external radiation therapy.

25. Patient-Centered Care: To prevent the debilitating cycle of fatiguedepression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program. b. Ignore the fatigue as much as possible. c. Do the most stressful activities when fatigue is tolerable. d. Schedule rest periods throughout the day whether fatigue is present or not.

25. a. Walking programs, or activity the patient enjoys, scheduled during the time of day when the patient feels better are a way for patients to keep active without overtaxing themselves, stimulate appetite, enhance functional capacity, and help combat the depression caused by inactivity. Ignoring the fatigue or overstressing the body can make symptoms worse. The patient should rest before activity and as necessary

26. When the patient asks about the late effects of chemotherapy and high-dose radiation, what areas of teaching should the nurse plan to include when describing these effects? a. Third space syndrome b. Secondary malignancies c. Chronic nausea and vomiting d. Persistent myelosuppression

26. b. Alkylating chemotherapeutic agents and high-dose radiation are most likely to cause secondary malignancies as a late effect of treatment, especially leukemia, angiosarcoma, and skin cancer. The other conditions are not known to be late effects of radiation or chemotherapy.

28. Priority Decision: While caring for a patient who is at the nadir of chemotherapy, the nurse establishes the highest priority for nursing actions related to a. diarrhea. b. grieving. c. risk for infection. d. nutritional intake.

28. c. The nadir is the point of the lowest blood counts after chemotherapy is started, and it is the time when the patient is most at risk for infection. Because infection is the most common cause of morbidity and death in cancer patients, identification of risk and interventions to protect the patient are of the highest priority. The other problems will be treated, but they are not the priority.

A 60-year-old client with gastric cancer has a shiny tongue, paresthesias of the limbs, and ataxia. The laboratory results show cobalamin levels of 125 pg/mL. Which medication would the nurse consider to be a high priority for the client? 1 Oral hydroxyurea Correct2 Vitamin B12 injections 3 Oral iron supplements

A shiny tongue, paresthesias of the limbs, ataxia, and cobalamin of 125 pg/mL (normal: 200- 835 pg/mL) are the manifestations of pernicious anemia. The client has pernicious anemia due to a vitamin B12 deficiency and should be given vitamin B12 injections. Vitamin B12 cannot be given orally to a client with pernicious anemia because the client does not produce the intrinsic factors needed to absorb Vitamin B12. Hydroxyurea is administered orally to clients with hemochromatosis. Oral iron supplements are given to clients with iron deficiency anemia. Erythropoietin injections are given to clients who have low red blood cells, hemoglobin, and hematocrit.

What information from a client's history should the nurse identify as risk factors for the development of colon cancer? Select all that apply. 1 Hemorrhoids Correct2 Increased age 3 High-fiber diet Correct4 Ulcerative colitis

A slower fecal transit time, which occurs with aging, may increase the risk for colon cancer. Chronic irritation of the intestinal mucosa, such as occurs in ulcerative colitis, increases the risk for colon cancer. Hemorrhoids are not a risk factor; they are associated with constipation. A high-fiber diet is linked to a decreased risk for colon cancer. Low hemoglobin level is not a risk factor for colon cancer; this may occur as a result of cancer and its therapies

37. The nurse assesses a patient with non-Hodgkins lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? a. Shortness of breath b. Temperature 100.2 F (37.9 C) c. Shivering and complaint of chills d. Generalized muscle aches and pains

ANS: A Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the health care provider. The other findings will also require action by the nurse, but are not indicative of life-threatening complications

33. When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP assists the patient to use dental floss after eating. b. The UAP adds baking soda to the patients saline oral rinses. c. The UAP puts fluoride toothpaste on the patients toothbrush. d. The UAP has the patient rinse after meals with a saline solution.

ANS: A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient

6. A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is most appropriate? a. The cancer involves only the cervix. b. The cancer cells look almost like normal cells. c. Further testing is needed to determine the spread of the cancer. d. It is difficult to determine the original site of the cervical cancer.

ANS: A Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread.

1. The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

ANS: A, C, D, E The patients age, gender, and history indicate a need for screening and/or teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy

2. A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)? a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work done.

ANS: A, C, E Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics

15. The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.

ANS: B Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapeutic drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.

34. The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patients bedpan. b. The UAP stands by the patients bed for 30 minutes talking with the patient. c. The UAP places the patients bedding in the laundry container in the hallway. d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.

ANS: B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated

23. The home health nurse cares for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. I have frequent muscle aches and pains. b. I rarely have the energy to get out of bed. c. I experience chills after I inject the interferon. d. I take acetaminophen (Tylenol) every 4 hours.

ANS: B Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen every 4 hours.

28. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? a. The patient ambulates several times a day in the room. b. The patients visitors bring in some fresh peaches from home. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

ANS: B Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help prevent skin breakdown and infection

38. A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.

ANS: B Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression

21. A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.

ANS: C For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics also may be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route, and usually the oral route is preferred

29. The nurse is caring for a patient who has been diagnosed with stage I cancer of the colon. When assessing the need for psychologic support, which question by the nurse will provide the most information? a. How long ago were you diagnosed with this cancer? b. Do you have any concerns about body image changes? c. Can you tell me what has been helpful to you in the past when coping with stressful events? d. Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?

ANS: C Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patients need for support. The patients knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time

10. External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.

ANS: C Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation

35. The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? a. 35-year-old patient who has wet desquamation associated with abdominal radiation b. 42-year-old patient who is sobbing after receiving a new diagnosis of ovarian cancer c. 24-year-old patient who received neck radiation and has blood oozing from the neck d. 56-year-old patient who developed a new pericardial friction rub after chest radiation

ANS: C Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening

19. The nurse taking a focused health history for a patient with possible testicular cancer will ask the patient about a history of a. testicular torsion. b. testicular trauma. c. undescended testicles. d. sexually transmitted infection (STI).

ANS: C Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STI, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer

25. The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the health care provider? a. The patient complains of fatigue. b. The patient eats only 25% of meals. c. The patients apical pulse is irregular. d. The patients white blood cell (WBC) count is 5000/L.

ANS: C Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.

2. During a well woman physical exam, a 43-year-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? a. Do you currently smoke tobacco? b. Have you ever had a breast injury? c. At what age did you start having menstrual periods? d. Is there a family history of fibrocystic breast changes?

ANS: C Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

39. The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? a. Hematocrit 32% b. Pain with deep inspiration c. Serum sodium 126 mEq/L d. Decreased breath sounds on left side

ANS: C Syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an oncologic metabolic emergency and will require rapid treatment in order to prevent complications such as seizures and coma. The other findings also require intervention, but are common in patients with lung cancer and not immediately life threatening

41. After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/L after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5 F (38.1 C) d. Patient who is worried about getting the prescribed long-acting opioid on time

ANS: C Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The other patients also require assessments or interventions, but do not need to be assessed as urgently. Patients with thrombocytopenia do not have spontaneous bleeding until the platelets are 20,000/L. Xerostomia (dry mouth) does not require immediate intervention. Although breakthrough pain needs to be addressed rapidly, the patient does not appear to have breakthrough pain

1. A patient who is scheduled for a right breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. Benign tumors do not cause damage to other tissues. b. Benign tumors are likely to recur in the same location. c. Malignant tumors may spread to other tissues or organs. d. Malignant cells reproduce more rapidly than normal cells.

ANS: C The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur.

13. A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? a. There are several options that I can consider for treating the cancer. b. I will probably need radiation to the breast after having the surgery. c. Mastectomy is the best choice to decrease the chance of cancer recurrence. d. I can probably have reconstructive surgery at the same time as a mastectomy.

ANS: C The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment

32. The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit of 30% (normal 41-50) b. Platelets of 95,000/L (normal 150k-450k) c. Hemoglobin of 10 g/L (normal 13.5-17.5) d. White blood cell (WBC) count of 2700/L

ANS: D The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy

18. A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. Rinse the mouth before and after each meal and at bedtime with a saline solution.

ANS: D The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended

31. The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider? a. Poor oral intake b. Frequent loose stools c. Complaints of nausea and vomiting d. Increase in carcinoembryonic antigen

ANS: D An increase in CEA indicates that the chemotherapy is not effective for the patients cancer and may need to be modified. The other patient findings are common adverse effects of chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy.

30. The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? a. Generalized muscle aches b. Complaints of nausea and anorexia c. Oral temperature of 100.6 F (38.1 C) d. Crackles heard at the lower scapular border

ANS: D Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2

28. A 76-year-old patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. The nurse will plan to a. vaccinate the patient with sipuleucel-T ( Provenge). b. provide the patient with information about cryotherapy. c. teach the patient about placement of intraurethral stents. d. schedule the patient for annual prostate-specific antigen testing.

ANS: D Patients who opt for active surveillance need to have annual digital rectal exams and prostate-specific antigen testing. Vaccination w/ sipuleucel-T, cryotherapy, and stent placement are options for patients who choose to have active treatment for prostate cancer.

40. An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient complains of severe fatigue. b. Patient needs to void every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has audible crackles to the midline posterior chest

ANS: D Rapid fluid infusions may cause heart failure, especially in older patients. The other findings are common in patients who have cancer and/or are receiving chemotherapy

2. The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect? a. Nausea b. Alopecia c. Mucositis d. Hematuria

ANS: D The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

24. A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patients teaching plan? a. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone. b. Donor bone marrow cells are transplanted through an incision into the sternum or hip bone. c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. d. Hospitalization will be required for several weeks after the stem cell transplant procedure is performed.

ANS: D The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room or incision required.

36. Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration? a. Teach the patient to rest the brain by avoiding new activities. b. Teach that chemo-brain is a short-term effect of chemotherapy. c. Report patient symptoms immediately to the health care provider. d. Suggest use of a daily planner and encourage adequate rest and sleep.

ANS: D Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop chemo-brain while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short- or long-term. There is no urgent need to report common chemotherapy side effects to the provider

tumor lysis syndrome

Chemotherapy can cause massive destruction of cells leading the creation of uric acid which can be toxic to the kidneys leading to Acute Tubular Necrosis. You can try to prevent this with hydration and allopurinol (uric acid reducer)

what life threatening conditions can TLS result in?

Hyperkalemia (>5.0 mEq/L [5.0 mmol/L]) that can cause lethal dysrhythmias Large amounts of nucleic acids (normally converted to uric acid and excreted by the kidneys) that can overwhelm the kidneys and cause hyperuricemia and acute kidney injury (AKI) from uric acid crystal formation Hyperphosphatemia (>4.4 mg/dL [1.42 mmol/L]) that can cause AKI and dysrhythmias Hypocalcemia (<8.6 mg/dL [2.15 mmol/L]) that can cause tetany and cardiac dysrhythmias

A client in a debilitated state is admitted for palliative treatment following a terminal diagnosis of liver cancer. Which objective information collected by the nurse is most helpful for future monitoring of the client's condition? 1 Description of the client's pain 2 Assessment of hunger 3 Inspection of bowel patterns Correct4 Record of daily weights

Weight is objective information that aids in determining the extent of ascites; one liter of retained fluid equals approximately 2.2 lb (1 kg). Ascites can develop in the late stages of liver cancer, and the effects of cancer and dying cause weight loss. The client's description of pain, hunger, and bowel patterns are helpful but not objective.

The nurse is providing education to a client with cancer radiation treatment options. The nurse determines that the client understands the teaching when the client states that which type of radiation aims to protect healthy tissue during the treatment?

brachytherapy because it is localized through an implant