PrepU Chapter 15: Oncologic Disorders

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 psychiatric diagnosis everyone has at one time or another. -A side effect of the neoplastic drugs. -A normal reaction to the diagnosis of cancer. -An aberrant psychologic reaction to the chemotherapy.

-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.

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 -Rinses the client's mouth with alcohol-based mouthwash every 2 hours -Instructs the client to brush the teeth with a soft toothbrush -Consults with the healthcare provider about use of nystatin -Teaches the client to floss the teeth once every 24 hours

-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.

A decrease in circulating white blood cells (WBCs) is referred to as -Granulocytopenia -Thrombocytopenia -Leukopenia -Neutropenia

-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 nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? -White blood cell (WBC) count of 9,000 cells/mm3 -Stage 3 pressure ulcer on the left heel -Temperature of 98.3° F (36.8° C) -Ate 75% of all meals during the day

-Stage 3 pressure ulcer on the left heel A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.

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? -Neutropenia -Extravasation -Nadir -Stomatitis

-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 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 -Angiogenesis -Stomatitis -Fatigue

-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.

Which of the following is the single largest preventable cause of cancer? -Tobacco -Pesticides -Arsenic -Asbestos

-Tobacco Tobacco remains the single largest preventable cause of disease and early death and accounts for at least 30% of all cancer deaths. The list of suspected carcinogens, such as pesticides, arsenic, and asbestos, continues to grow.

The nurse is evaluating the client's risk for cancer. What lifestyle change should the nurse recommend? -uses the treadmill for 30 minutes on 5 days each week -eats red meat such as steaks or hamburgers every day -works as a secretary at a medical radiation treatment c -enter drinks one glass of wine at dinner each night

-eats red meat such as steaks or hamburgers every day Dietary substances such as nitrate-containing, nitrite-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.

Palliation refers to -the spread of cancer cells from the primary tumor to distant sites. -hair loss. -relief of symptoms of disease and promotion of comfort and quality of life. -the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.

-relief of symptoms of disease and promotion of comfort and quality of life. Palliation is the goal for care of clients 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.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? -Control -Cure -Palliation -Prevention

-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.

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: -expected chemotherapy-related adverse effects. -chemotherapy exposure and risk factors. -signs and symptoms of infection. -reinforcement of the client's medication regimen.

-chemotherapy exposure and risk factors. The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.

Which is a sign or symptom of septic shock? -Hypertension -Warm, moist skin -Altered mental status -Increased urine output

-Altered mental status Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? -Liver -Colon -Reproductive tract -White blood cells (WBCs)

-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.

An important nursing function is monitoring factors that may indicate that bleeding is occurring. One serum indicator is a (an): -Lymphocyte count of 30%. -Platelet count of 60,000/mm3. -Neutrophil count of 60%. -Reticulocyte count of 1%.

-Platelet count of 60,000/mm3. Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer and is usually defined as a count less than 100,000/mm3. The risk of bleeding increases as the count drops lower. The risk of spontaneous bleeding occurs with a count of less than 20,000/mm3.

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. -Alopecia related to chemotherapy is relatively uncommon. -The hair will grow back within 2 months post therapy. -The hair will grow back the same as it was before treatment.

-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.

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 will eat clear liquids for the next 24 hours." -"Hair loss may not occur until after the second round of therapy." -"I will use birth control measures until after all treatment is completed." -"I can continue taking my vitamins and herbs because they make me feel better."

-"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.

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 -Incisional biopsy -Needle biopsy -Punch biopsy

-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 conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? -Onset of cancer after age 50 in family member -A first cousin diagnosed with cancer -A second cousin diagnosed with cancer -An aunt and uncle diagnosed with cancer

-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.

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 injury -Imbalanced nutrition: Less than body requirements -Risk for infection -Anxiety

-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.

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." -"New hair growth will return without any change to color or texture." -"Clients with alopecia will have delay in grey hair." -"Wigs can be used after the chemotherapy is completed."

-"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.

While doing a health history, a client tells you that her mother, her grandmother, and her sister died of breast cancer. The client wants to know what she can do to keep from getting cancer. What would be your best response? -"You can't prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is." -"If you eat right, exercise, and get enough rest, you can always prevent breast cancer." -"With your family history, there is nothing you can do to prevent getting cancer." -"Cancer often skips a generation, so don't worry about it."

-"You can't prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is." Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. Options B and C are incorrect and giving the client these responses would be giving inaccurate information. Options D is incorrect because it minimizes and negates the client's concern.

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." -"You will continue having your menses every month." -"You will experience menopause now." -"You will be unable to have children."

-"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 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? -Taking the client's temperature rectally -Providing commercial mouthwash to the client -Providing a razor so the client can shave -Avoiding the use of products containing aspirin

-Avoiding the use of products containing aspirin Clients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding the use of products such as aspirin that may interfere with the client's clotting systems; avoiding taking temperature rectally and administering suppositories; providing the client with an electric shaver for shaving; and avoiding commercial mouthwashes because of their potential to dry out oral mucosa, which can lead to cracking and bleeding.

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 -Applying talcum powder to the irradiated areas daily after bathing -Wearing a lead apron during direct contact with the client -Removing thoracic skin markings after each radiation treatme

-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 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? -Perform a cardiovascular assessment every 4 hours. -Check the client's history for a congenital link to thrombocytopenia. -Monitor daily platelet counts. -Closely observe the client's skin for petechiae and bruising.

-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.

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? -Stay away from protein beverages. -Encourage maximum fluid intake. -Encourage eating cheese, eggs, and legumes -Suck on hard candy during treatment.

-Encourage eating cheese, eggs, and legumes The nurse encourages the clients with taste changes to eat cheese, eggs, and legumes. Encouraging the client to take in the maximum amount of fluids does not increase protein intake. The nurse advises the client to drink protein beverages. Sucking on hard candies during treatment does not increase protein intake.

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. -Take measures to acidify the urine and prevent uric acid crystallization. -Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. -Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

-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.

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? -Palliative surgery -Prophylactic surgery -Curative surgery -Reduction surgery

-Prophylactic surgery Prophylactic or preventive surgery may be done if the client is at considerable risk for cancer. Palliative surgery is done when no curative treatment is available. Curative surgery is performed to cure the disease process. Reduction surgery is a distractor.

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? -Clarify information provided by the physician. -Provide aseptic care to the incision postoperatively. -Provide time for the patient to discuss her concerns. -Counsel the patient about the possibility of losing her breast.

-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.

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 -Fatigue related to deficient blood cells -Activity intolerance related to side effects of chemotherapy -Anxiety related to change in role function

-Risk for infection related to inadequate defenses Physiological needs, such as risk for infection, take priority over the client's other needs.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? -Urine output of 400 ml in 8 hours -Serum potassium level of 2.6 mEq/L -Blood pressure of 120/64 to 130/72 mm Hg -Sodium level of 142 mEq/L

-Serum potassium level of 2.6 mEq/L Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately -Stops the chemotherapeutic infusion -Administers diphenhydramine -Gives prednisolone IV -Places the client on oxygen by nasal cannula

-Stops the chemotherapeutic infusion The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.