Chapt 15 Oncology Med Surg
In which phase of the cell cycle does cell division occur? a) Mitosis b) S phase c) G1 phase d) G2 phase
Mitosis Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase.
Which of the following is a term used to describe the process of programmed cell death? a) Mitosis b) Angiogenesis c) Apoptosis d) Carcinogenesis
Apoptosis Correct Explanation: Apoptosis is the innate cellular process of programmed cell death. Mitosis is the phase of the cell cycle in which cell division occurs. Carcinogenesis is the process by which cancer arises. Angiogenesis is the process by which a new blood supply is formed.
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 a) "You will be unable to have children." b) "You will continue having your menses every month." c) "You will need to practice birth control measures." d) "You will experience menopause now."
"You will need to practice birth control measures." Correct Explanation: 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.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? a) Withholding fluids for the first 4 to 6 hours after chemotherapy administration b) Serving small portions of bland food c) Encouraging rhythmic breathing exercises d) Administering metoclopramide (Reglan) and dexamethasone (Decadron) as ordered
Administering metoclopramide (Reglan) and dexamethasone (Decadron) as ordered The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.
The nurse is conducting a screening for familial predisposition of cancer. Which of the following should the nurse note as a possible indication of hereditary cancer syndrome? a) Onset of cancer after age 50 in family member b) A second cousin diagnosed with cancer c) A first cousin diagnosed with cancer d) An aunt and uncle diagnosed with cancer
An aunt and uncle diagnosed with cancer Correct Explanation: 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, 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.
The nurse is evaluating bloodwork results of a patient with cancer who is receiving chemotherapy. The patient's platelet count is 60,000/mm3. Which of the following is an appropriate nursing action?
Avoiding use of products containing aspirin Patients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding use of products such as aspirin that may interfere with the patient's clotting systems; avoiding taking temperature rectally and administering suppositories; providing patient with an electric shaver for shaving; and avoiding commercial mouthwashes due to 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? a) Removing thoracic skin markings after each radiation treatment b) Wearing a lead apron during direct contact with the client c) Avoiding using soap on the irradiated areas d) Applying talcum powder to the irradiated areas daily after bathing
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? a) Check the client's history for a congenital link to thrombocytopenia. b) Perform a cardiovascular assessment every 4 hours. c) Closely observe the client's skin for petechiae and bruising. d) Monitor daily platelet counts.
Closely observe the client's skin for petechiae and bruising. Explanation: The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.
The nurse is providing education to a patient with cancer radiation treatment options. The nurse determines that the patient understands when he or she states that which of the following types of radiation is aimed at protecting healthy tissue during the treatment? a) External b) Brachytherapy c) Teletherapy d) Proton therapy
Correct response: Brachytherapy Explanation: In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body by use of an implant. With this type of therapy, the further the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.
The nurse is working with a patient who has had an allohematopoietic stem cell transplant (HSCT) and notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the patient has symptoms of which of the following? a) Metastasis b) Nadir c) Acute leukopenia d) Graft-versus-host disease
Graft-versus-host disease Correct Explanation: Graft-versus-host disease is a major cause of morbidity and mortality in patients who have had allogeneic transplant. Clinical manifestation of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire GI tract with subsequent diarrhea, abdominal pain, and hepatomegaly.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? a) Providing for frequent rest periods b) Placing the client in strict isolation c) Inspecting the skin for petechiae once every shift d) Administering aspirin if the temperature exceeds 102° F (38.8° C)
Inspecting the skin for petechiae once every shift Explanation: Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
The nurse is assessing the diet of a female client. To decrease the risk of cancer in general, the nurse instruction the client to: a) decrease cigarette smoking from 2 packs a day to 1/2 a pack a day b) limit alcohol ingestion to one drink per day c) increase fruit/vegetable servings to 2-3 servings a day
Limit alcohol ingestion to one drink per day. Correct Explanation: Alcohol increases the risks of certain cancers and should be limited to no more than one drink per day for women. Smoking is strongly associated with certain cancers, and tobacco may act synergistically with other substances. Even decreasing use of tobacco still places one at risk for cancer. Recommendation by the U.S. Department of Agriculture for fruits and vegetables is 4 1/2 cups per day and for protein is 5 1/2 ounces per day with low-fat or lean meat and poulty and/or other proteins such as fish, beans, peas, nuts, and seeds.
A client has received several treatments of bleomycin. It is now important for the nurse to assess a) Urine output b) Lung sounds c) Skin integrity d) Hand grasp
Lung sounds Correct Explanation: Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? a) The I.V. site is red and swollen. b) The client begins to shiver. c) The laboratory reports a white blood cell (WBC) count of 1,000/mm3. d) The client states he is nauseous.
The I.V. site is red and swollen. Correct Explanation: A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time.
The nurse is evaluating the client's risk for cancer and recommends changes when the client states she a) uses the treadmill for 30 minutes on 5 days each week b) drinks 1 glass of wine at dinner each night c) eats red meat such as steaks or hamburgers every day d) works as a secretary at a medical radiation treatment center
eats red meat such as steaks or hamburgers every day Explanation: 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. It is OK to drink 1 glass of wine per day.
Which of the following occurs when there is accumulation of fluid in the pericardial space that compresses the heart? a) Cardiac tamponade b) DIC c) SIADH d) Superior Vena Cava Syndrome (SVCS)
Cardiac tamponade Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when there is a compression or invasion of the superior vena cava by a tumor, enlarged lymph nodes, intraluminal thrombosis that obstructs venous circulation, or drainage of the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis which results in thrombosis or bleeding.
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? a) Serum potassium level of 2.6 mEq/L b) Sodium level of 142 mEq/L c) Blood pressure of 120/64 to 130/72 mm Hg d) Urine output of 400 ml in 8 hours
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 caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?
"I floss my teeth every morning." Correct Explanation: A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.
Which of the following is a sign or symptoms of septic shock? a) Increased urine output b) Warm, moist skin c) Altered mental status d) Hypertension
Altered mental status Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.
Which of the following is a term used to described the process by which a new blood supply is formed?
Angiogenesis Angiogenesis is the process by which a new blood supply is formed. Apoptosis is the innate cellular process of programmed cell death. Mitosis is the phase of the cell cycle in which cell division occurs. Carcinogenesis is the process by which cancer arises.
A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? a) Impaired swallowing b) Chronic low self-esteem c) Disturbed body image d) Anticipatory grieving
Anticipatory grieving Correct Explanation: Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn't associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn't disfiguring and doesn't cause Disturbed body image. Chronic low self-esteem isn't an appropriate nursing diagnosis at this time because the diagnosis has just been made.
A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client? a) Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. b) Nausea and vomiting are only a factor for the first 24 hours after treatment. c) Most clients believe the discomfort is well worth the cure for cancer. d) Clinical trials are opening up new cancer treatments all the time.
Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Correct Explanation: Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? a) Throw I.V. tubing in the trash after the infusion is stopped. b) Disconnect I.V. tubing with gloved hands. c) Wear disposable gloves and protective clothing. d) Break needles after the infusion is discontinued.
Wear disposable gloves and protective clothing. A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? a) Autologous b) Allogeneic c) Syngeneic d) Homogenic
Allogeneic Explanation: If the source of donor cells is from a donor other than the patient, it is termed allogeneic. Autologous donor cells come from the patient. Syngeneic donor cells are from an identical twin. Homogenic is not a type of stem cell transplant.
Which of the following does a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? a) Blood studies b) Allergy history c) Family history d) Drug history
Blood studies Correct Explanation: Before the BMT procedure, the nurse thoroughly evaluates the patient's physical condition; organ function; nutritional status; complete blood studies, including assessment for past antigen exposure, such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate patient's family, drug, or allergy history.
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean? a) No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis b) Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis c) Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis d) Can't assess tumor or regional lymph nodes and no evidence of metastasis
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3. Primary Tumor (T) TX: Primary tumor cannot be evaluated T0: No evidence of primary tumor Tis: Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue; although not cancer, CIS may become cancer and is sometimes called preinvasive cancer) T1, T2, T3, T4: Size and/or extent of the primary tumor Regional Lymph Nodes (N) NX: Regional lymph nodes cannot be evaluated N0: No regional lymph node involvement N1, N2, N3: Degree of regional lymph node involvement (number and location of lymph nodes) Distant Metastasis (M) MX: Distant metastasis cannot be evaluated M0: No distant metastasis M1: Distant metastasis is present
According to the tumor-node-metastasis (TNM) classification system, T0 means there is which of the following?
No evidence of primary tumor T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? a) Prolongation b) Progression c) Promotion d) Initiation
Progression Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents, escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.
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? a) Curative surgery b) Palliative surgery c) Reduction surgery d) Prophylactic surgery
Prophylactic surgery Correct Explanation: 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.
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? a) "The hair loss is temporary." b) "Clients with alopecia will have delay in grey hair." c) "Wigs can be used after the chemotherapy is completed." d) "New hair growth will return without any change to color or texture."
"The hair loss is temporary." Correct Explanation: 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.
Which of the following does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? a) Drug history b) Allergy history c) Blood studies d) Family history
Blood studies Correct Explanation: Before the HSCT procedure, the nurse thoroughly evaluates the patient's physical condition; organ function; nutritional status; complete blood studies, including assessment for past antigen exposure, such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before an HSCT procedure, the nurse need not evaluate patient's family, drug, or allergy history.
The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks? a) Hand washing and infection prevention b) Breast and testicular self-exams c) Sun safety and use of sunscreen d) Pool and water safety
Correct response: Sun safety and use of sunscreen Explanation: Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.
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? a) Anxiety b) Risk for infection c) Risk for injury d) Imbalanced nutrition: Less than body requirements
Risk for infection Risk for infection takes highest priority in clients with severe bone marrow depression because they have a decrease in the number of white blood cells, the cells that fight infection. Making clients aware that they are at risk for injuries can help prevent such injuries as falls. The nurse should institute the facility's falls prevention protocol and supply assistive devices, such as a walker, cane, or wheelchair, when needed. Imbalanced nutrition: Less than body requirements is also of concern but doesn't take priority over preventing infection. Anxiety is likely present in clients with severe bone marrow depression; however, anxiety doesn't take priority over preventing infection.
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? a) Temperature of 98.3° F (36.8° C) b) Stage 3 pressure ulcer on the left heel c) White blood cell (WBC) count of 9,000 cells/mm3 d) Ate 75% of all meals during the day
Stage 3 pressure ulcer on the left heel Correct Explanation: 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.
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? a) "I'll wear protective clothing when outside." b) "I'll wash my skin with mild soap and water only." c) "I'm worried I'll expose my family members to radiation." d) "I'll not use my heating pad during my treatment."
"I'm worried I'll expose my family members to radiation." Correct Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
You are an oncology nurse giving chemotherapy in a short stay area. One client confides to you that they are very depressed. What is depression? a) A psychiatric diagnosis everyone has at one time or another. b) A side effect of the neoplastic drugs. c) A normal reaction to the diagnosis of cancer. d) An aberrant psychologic reaction to the chemotherapy.
A normal reaction to the diagnosis of cancer. Correct Explanation: 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. Options A, B and D are incorrect. 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.
While administering cisplatin (Platinol-AQ) to a client, the nurse assesses swelling at the insertion site. The first action of the nurse is to a) Administer a neutralizing solution. b) Discontinue the intravenous medication. c) Apply a warm compress. d) Aspirate as much of the fluid as possible.
Discontinue the intravenous medication. If extravasation of a chemotherapeutic medication is suspected, the nurse immediately stops the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.
