Chapter 12 Management of patients with oncologic disorders

An oncology nurse is contributing to the care of a client who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRMs). the nurse should know that these achieve a therapeutic effect by what means?

Altering the immunologic relationship between the tumor and the client.

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?

Closely observe the client's skin for petechiae and bruising.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?

Control

The nurse is preparing a teaching tool about alopecia caused by cancer treatment. Which information will the nurse emphasize in this tool?

Cut long hair before treatment begins, use a wide tooth comb to style the hair, avoid hair dyes or permanent wave solutions

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?

Encourage fluid intake to dilute the urine.

A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient?

Explain to the patient that she will continue to emit radiation while the implant is in place.

Chemotherapeutic agents have which effect associated with the renal system?

Increased uric acid excretion

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?

Inspecting the skin for petechiae once every shift.

An oncology client will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another?

Invading healthy host tissues

A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician order mitomycin and other chemotherapeutic agents for palliative treatments. How does mitomycin exert its cytotoxic effects?

It inhibits DNA synthesis

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse?

It lowers serum and uric acid levels.

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy?

It removes a wedge of tissue for diagnosis.

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen?

It targets normal body cells as well as cancer cells.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?

Liver

Cancer is the second leading cause of death in the US, second only to heart disease. Half of all men and one third of all women will develop cancer during their lifetimes. Which types of cancer have the highest prevalence among both men and women?

Lung and colon

A client has received several treatments of bleomycin. It is now important for the nurse to assess

Lung sounds.

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest?

Malignant tumor

In which phase of the cell cycle does cell division occur?

Mitosis

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a bone marrow transplant?

Monitor the client closely to prevent infection

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client?

Monitor the client to prevent sepsis.

A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend?

Oranges

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 given via a peripherally inserted central catheter.

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action?

Place the client in a private room.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior?

Progression

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently report swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?

Stomatitis

The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as

brachytherapy

Carcinogens are factors related to the formation of various malignancies. Which factor has the greatest impact on the development of all cancers?

chemical agents

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include:

chemotherapy exposure and risk factors.

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply.

dietary substances, environmental factors, viruses

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?

excisions biopsy

The nurse is working with a client who has had an all-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of

graft-versus-host disease

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?

ham and bacon

A client with a recent history of GI disturbance has been scheduled for a barium study. The physician ordered this particular test for this client because it will:

show movement of the GI tract.

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice?

eats red meat such as steaks or hamburgers every day

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching?

prophylactic

The nurse at the clinic explains to the patient that the surgeon will be removing a mole on the patient's back that has the potential to develop into cancer. The nurse informs the patient that this is what type of procedure?

prophylactic

The drug interleukin-2 is an example of which type of biologic response modifier?

Cytokine

A nurse is caring for a 29 year old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment?

I'll only need chemotherapy treatment before receiving my bone marrow transplant.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching?

I'm worried I'll expose my family members to radiation.

Which statement is true about malignant tumors?

They gain access to the blood and lymphatic channels

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?

Tumor pressure against normal tissues

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?

Wear disposable gloves and protective clothing.

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?

An aunt and uncle diagnosed with cancer

After being seen in the oncology clinic, a client with sever 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 infection

A client is receiving radiation therapy and asks the nurse about oral hygiene. What teaching specific to the client's situation should the nurse include?

Use a soft toothbrush and allow it to air dry before storing.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

Administering metoclopramide and dexamethasone as ordered.

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?

Allogeneic

A client is recovering from a craniotomy with tumor debunking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed.

"I guess the doctor could not remove the entire tumor."

A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse?

"It will allow time for the repair of healthy tissue."

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 normal reaction to the diagnosis of cancer.

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."

The client is to receive cyclophosphamide (cytoxan) 50mg/kg IV in divided doses over 5 days. The client weighs 176 pounds. How many mg of cyclophosphamide will the client receive each day?

800

Following surgery for adenocarcinoma, the client learns the tumor stage is T3, N1, M0. What treatment mode should the nurse anticipate?

Adjuvant therapy is likely.

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise?

Avoid spicy and fatty foods.

A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan?

Avoiding using soap on the irradiated areas.

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 terms are significant to indicate the likelihood of the tumor spreading?

Benign, neoplasm, angiogenesis

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?

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis.

Which oncological emergency involves the accumulation of fluid in the pericardial space?

Cardiac tamponade

A patient is schedule for cry-ablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse?

The surgeon is going to use liquid nitrogen to freeze the area.

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?

Extravasation

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because:

The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.

The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse?

I can continue taking my vitamins and herbs because they make me feel better.

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful?

I clean my teeth gently several times per day

A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis?

Provide a solution of viscous lidocaine for use as a mouth rinse.

A patient is admitted for an excisions biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?

Provide time for the patient to discuss her concerns.

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

Psychological status

A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis?

Red, open sores on the oral mucosa

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?

The IV site is red and swollen.

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.

What is the best way for the nurse to assess the nutritional status of a patient with cancer?

Weigh the patient daily.

A nurse is assessing a 75 year old woman who had a total hysterectomy when she was 30 years old and normal pap test results for the past 10 years. The client asks about continuing the pap test. What is the best response by the nurse?

You may choose to discontinue this test

Which is a sign or symptom of septic shock?

altered mental status

A decrease in circulating white blood cells (WBCs) is referred to as

leukopenia

The nurse is assessing the diet of a female client. To decrease the risk of cancer in general, the nurse instructs the client to

limit alcohol ingestion to one drink per day.

A patient is takin vincristine, a plant alkaloid for the treatment of cancer. What system should the nurse be sure to assess for symptoms of toxicity?

nervous system

According to the tumor-node-metastasis (TNM) classification system, T0 means there is

no evidence of primary tumor

Which type of surgery is used in an attempt to relieve complications of cancer?

palliative

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.

Which of the following would be inconsistent as a common side effect of chemotherapy?

weight gain

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?

Antimetabolite

Which doing a health history, a client tells the nurse that her mother, grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse?

Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level.

A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to:

increase her intake of calcium-rich foods

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.

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 10^12/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

The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective?

I will brush my teeth after every meal.

When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?

Inspect the skin frequently