Oncology review questions

The nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask?

"Have you had a fever?" An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.

Patients may reduce the risk of developing cancer using health promotion strategies.Identify strategies which can reduce the risk of developing cancer (select all that apply.).

Control weight Genetic testing Immunizations Use sunscreen Stop smoking Limit alcohol intake

The nurse is caring for an 18-yr-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure?

"Before the transplant, I will have chemotherapy and possibly full-body radiation." Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy?

1 tsp salt in 1 L water mouth rinse A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer?

Body mass index of 35 kg/m2 and smoking cigarettes for 20 years Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading?

Cells are abnormal and moderately differentiated. Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient?

Epstein-Barr virus Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider?

Serum sodium level of 118 mEq/L Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.

Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development?

"Follow smoking cessation recommendations." The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Cigarette smoking is a promoting factor and a carcinogen. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be consistent with the nurse's role.

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. Which question would best determine treatment measures for the patient's pain?

"What does the pain feel like?" The UAP told the nurse the location of the patient's pain and the patient reports worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient?

"You can get a wig now to match your hair so you will not look different." The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back it could be a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis?

"Your cancer was identified in the cervix and has limited local spread." Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as to the liver.

The nurse is conducting a history and monitoring lab values on a client with multiple meyloma. What assessment findings should the nurse expect to note? 1. Pathological fx 2. UA positive for nitrates 3. Hgb level of 15.5 4. Calcium level of 8.6 5. Serum creatinine level of 2.0

1,2,5

The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? 1. Facial edema in the morning 2. Weight loss of 20 lb in 1 month 3. Serum calcium level of 12 mg/dL 4. serum sodium level of 136 mg/dL 5. Serum potassium level of 3.4 mg/dL 6. Numbness and tingling of the lower extremities

1,3,6 Rationale: Oncological emergencies include sepsis, disseminated intravascular coagulation, SIADH, spinal cord compression, hypercalcemia, superior vena cava, and tumor lysis.

The nurse is caring for a client who is postoperative following a pelvic exenteration and the health care provider changes the clien's diet from NPO status to clear liquids. The nurse should check which priority item before administering the diet? 1. Bowel sounds 2. Ability to ambulate 3. Incision appearance 4. Urine specific gravity

1. Bowel sounds Rationale: The client is kept NPO until peristalsis returns, usually 4-6 days. When bowel function returns, clear fluids are given to the client.

The nurse is creating a plan of care for the client with multiple myeloma and includes with priority intervention in the plan? 1. Encouraging fluids 2 Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count

1. Encouraging fluids Rationale: Hypercalcemia caused by bone destruction is priority concern in the client with multiple myeloma. The nurse should administer fliods om adequate amounts to maintain UO of 1.5 to 2 L/day; this requires about 3L of fluid per day.

The nurse is reviewing the lab results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4. Decreased number of plasma cells in the bone marrow

1. Increased Calcium Level Rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level.

The home health nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client's pain should include which assessment? 1. The client's pain rating 2. nonverbal cues from the client 3. the nurse's impression of the client's pain 4. pain relief after appropriate nursing intervention

1. The client's pain rating Rationale: The pain is always what the patient says it is.

When caring for a client with an internal radiation implant, the nurse should observe which principles? SATA 1. Limiting the time with the client to 1 hour per shift 2. Keeping pregnant women out of the client's room 3. Private room/private bath 4.Wearing lead shield when providing direct care 5. Removing the disometer film badge when entering the client's room 6. Allowing individuals younger than 16 i nthe room as long as they are 6 ft. away from the client

2, 3, 4. Rationale: Time spent with the client per 8 hour shift should be 30 minutes. The client should be in a private room with a private bath. Lead shielding can reduce the transmission of radiation. Dosimeter film badge must be worn when in a clients room. Children 16 and under and pregnant women should not be allowed in the client's room.

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition? 1. Rupture of the bladder 2. The development of a vesicovaginal fistula 3. Extreme stress caused by the dx of cancer 4. Altered perineal sensation as a side effect of radiation therapy

2. Development of vesicovaginal fistula Rationale: A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina.

A gastrectomy is performed on a client with gastric cancer. In the immediate postop period, the nurse notes bloody drainage from the NG tube. The nurse should take which action? 1. Measure abdominal girth 2. Irrigate the NG tube 3. Continue to monitor the drainage 4. Notify the HCP

3. Continue to monitor the drainage Rationale: Following a gastrectomy, drainage from the NG tube is normally bloody for 24 hours.

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1. Restrict all visitors 2. Restrict fluid intake 3. Teach the client and family about the need for hand hygiene 4. Insert an indwelling urinary catheter to prevent skin breakdown

3. Teach the client and family about the need for hand hygiene Rationale: In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with infections.

During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease? 1. Diarrhea 2. Hypermenorrhea 3. Abnormal Bleeding 4. Abdominal distention

4. Abdominal distention Rationale: Clinical manifestation of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain.

A client is amitted to the hospital with suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? 1. Fatigue. 2. Weakness 3. weight gain 4. enlarged lymph nodes

4. Enlarged lymph nodes Rationale: Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver.

While giving care to a client with internal cervical radiation implant, the nurse finds the implant in the bed. The nurse should take which initial action? 1. Call the HCP 2. Reinsert the implant into the vagina 3. Pick up the implant with a gloved hand and flush it down the toilet 4. Pick up the implant with long handled forceps and place it in a lead container

4. Pick up the implant with a long handled forceps and place it in a lead container Rationale: In the event that a radiation source becomes dislodged, the nurse would encourage the client to lie still until the radioactive device has been placed in a safe container. The nurse would use long handle forceps to do this. The nurse would then call the radiation oncologist and document the event and actions taken. It is not within a nurse's scope of practice to insert a radiation implant.

Which patient is statistically and medically at the highest risk of developing cancer?

A 56-yr-old African American man with hepatitis C who drinks alcohol daily The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. The majority of cancer cases are diagnosed in individuals older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in African Americans, then whites, and then people from other cultures.

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery?

A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications?

Acetaminophen (Tylenol) Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic but is not used first to combat flu-like symptoms of headache, fever, chills, myalgias, and so on.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake?

Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

A patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin?

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

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency?

Hypocalcemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells?

Immunologic surveillance Immunologic surveillance is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

The patient is told that her adenoma tumor is not encapsulated but has normally differentiated cells and surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient?

It is probably benign. Benign tumors are usually encapsulated, have normally differentiated cells, and do not metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are capable of metastasis.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply.)?

Maintain hope. Exhibit a caring attitude. Be available to listen to fears and concerns.

A 64-yr-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to the plan of care?

Provide high-protein and high-calorie, soft foods every 2 hours. A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient?

The time the nurse spends at what distance from the patient The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first?

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