Chapter 15: Oncology Nursing

The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response?

"Benign tumors don't usually cause death."

The nurse is caring for a client is scheduled for chemotherapy followed by auto logous stem cell transplant. Which of the following statements by the client indicates a need for further teaching?

"I hope they find a bone marrow donor who matches."

A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit?

"I'll play card games with my friends."

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."

A patient is scheduled for cryosurgery for cervical cancer and tells the nurse, "I am not exactly sure what the doctor is going to do." What is the best response by the nurse?

"The physician is going to use liquid nitrogen to freeze the area."

Following a BMT the patient should be monitored for at least

3 months.

The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue?

95%

The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a negative biopsy report?

A wide excision of lump will be performed.

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

Administering metoclopramide and dexamethasone as ordered

A patient, age 67 years, is admitted for diagnostic studies to rule out cancer. The patient is Caucasian, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? (Select all that apply.)

Age Cigarette smoking Occupation

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

Allogeneic

Which of the following is a sign or symptoms of septic shock?

Altered mental status

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

Antimetabolite

Which type of vaccine uses the patient's own cancer cells, which are prepared for injection, back into the patient?

Autologous

Which of the following does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure?

Blood studies

The nurse is completing an admission assessment on a patient receiving interstitial implants for his prostate cancer. The nurse documents this as being which of the following?

Brachytherapy

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 oncologic emergency involves the accumulation of fluid in the pericardial space?

Cardiac tamponade

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?

Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects.

A 5-year-old client has just received stem cell transplantation as treatment for his leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation?

Closely monitor the client for at least 3 months.

A client with cancer is receiving chemotherapy and reports to the nurse that his mouth is painful and he has difficulty ingesting food. The nurse does which of the following:

Consults with the healthcare provider about use of nystatin (Mycostatin) Instructs the client to brush the teeth with a soft toothbrush Asks the client to open his mouth to facilitate inspection of the oral mucosa

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

Cytokine

What are considered carcinogens?

Dietary substances

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

Ease of bruising

You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes?

Encourage cheese and sandwiches.

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 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

A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client?

Fear

The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important?

Flush the toilet twice after every use.

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

The physician recommends that you have your daughter vaccinated with HPV vaccine. What is this vaccine for?

Help prevent cervical cancer

A benign tumor of the blood vessels is a

Hemangioma.

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.

Chemotherapeutic agents have which effect associated with the renal system?

Increase uric acid excretion

Which of the following is a characteristic of a malignant tumor?

It gains access to the blood and lymphatic channels.

The nurse is caring for a patient undergoing an incisional biopsy. Which of the following statements does the nurse understand is true about an incisional biopsy?

It removes a wedge of tissue for diagnosis.

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

Lung sounds

Which of the following is a growth-based classification of tumors?

Malignant

An important nursing function is monitoring factors that may indicate that bleeding is occurring. One serum indicator is a (an):

Platelet count of 60,000/mm3.

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?

Prophylactic surgery

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

Palliation refers to which of the following?

Relief of symptoms and promotion of comfort and quality of life

The nurse is caring for a patient with a benign breast tumor. The nurse plans care for a patient whose tumor has which of the following characteristics?

Slow rate of growth

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?

Stage 3 pressure ulcer on the left heel

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

A 79-year-old-male client is returning to your primary care practice for the results of his annual physical exam. He was without symptoms or complaints, yet he is returning to receive a diagnosis of prostate cancer. What factors contributed to this diagnosis? Select all that apply.

Suspect client history Risk factors Tumor markers

You are an oncology nurse caring for a client who is taking antineoplastic agents. What symptoms must you consider when monitoring this client?

Symptoms of gout

The client has received chemotherapy and 1 week later is at home experiencing nausea and vomiting. The first action of the nurse is to recommend

Taking prescribed ondansetron (Zofran)

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

The I.V. site is red and swollen.

The nurse is preparing to assess a patient whose chart documents that the patient experienced extravasation when receiving the vesicant Vincristine on the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which of the following? Select all that apply.

Tissue necrosis Effectiveness of antidote Sloughing tissue

Which of the following is the single largest preventable cause of cancer?

Tobacco

Your client is receiving radiation therapy. The client asks you about oral hygiene. What advice regarding oral hygiene should you offer?

Use a soft toothbrush and avoid an electronic toothbrush.

The nurse evaluates teaching as effective when a female client states that she will

Use sunscreen when outdoors.

A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client?

Wear personal protective equipment when handling blood, body fluids, and feces.

To combat the most common adverse effects of chemotherapy, a nurse should administer an:

antiemetic.

A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through:

inhalation of aerosols.

According to the TNM classification system, T0 means there is

no evidence of primary tumor.

A serum sodium level lower than 110 mEq/L is associated with

seizure.

A decrease in circulating white blood cells (WBC) is referred to as which of the following?

Leukopenia

A client is recovering from a craniotomy with tumor debulking. 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."

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."

The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis?

"My cancer has now spread to my liver."

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.

The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which of the following screening tests every 10 years?

Colonoscopy

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

A patient is admitted for an excisional 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.

During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?

Providing a solution of viscous lidocaine for use as a mouth rinse

When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor?

Radiation can result in myelosuppression.

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.

You are teaching clients about cancer prevention and explain that the root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) as a result from multiple factors. You explain that which of the following are possible carcinogens? Select all that apply.

Environmental factors Viruses Dietary substances

A patient with brain tumor is undergoing radiation and chemotherapy for treatment of cancer. Of late, the patient is complaining of swelling in the gums, tongue, and lips. Which of the following is the most likely cause of these symptoms?

Stomatitis

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

Liver

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.

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 oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)?

Syndrome of inappropriate antidiuretic hormone release (SIADH)

While completing an admission assessment, the client reports a family history of ovarian cancer among a maternal grandmother, aunt, and sister. The nurse knows that these cancers are most likely associated with what etiology?

Inherited gene mutation

When caring for a 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.

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

A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects?

It interferes with DNA replication and RNA transcription.

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."

The 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. The nurse states:

"You may choose to discontinue this test."

A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?

7 to 14 days

Which of the following classes of antineoplastic agents is cell cycle-specific?

Antimetabolites (5-FU)

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

Chemical agents

The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.

Egg white omelet with spinach and mushrooms Steamed broccoli and carrots Turkey breast on whole wheat bread

The nurse is caring for a client newly diagnosed with cancer. Which of the following therapies is used to treat something other than cancer?

Electroconvulsive therapy

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:

Encourage fluid intake, if possible, to dilute the urine.

Which grade of tumor is also known as a well-differentiated tumor?

Grade 1

A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician orders mitomycin (Mutamycin) and other chemotherapeutic agents for palliative treatment. How does mitomycin exert its cytotoxic effects?

It inhibits deoxyribonucleic acid (DNA) synthesis.

What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?

It lowers serum and uric acid levels.

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.

The oncologist advises a 32-year-old female client who had a lumpectomy 2 years previously to consider a mastectomy when her cancer reappears. This procedure would be considered which type of surgery?

Salvage

What should the nurse tell a female client who is about to begin chemotherapy and anxious about losing her hair?

She should consider getting a wig or cap before she loses her hair.

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?

Shorten the period of neutropenia

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 client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.)

assesses the client for any sun exposure avoids shaving the irradiated skin

The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is:

cell-cycle nonspecific.

The nurse is evaluating the client's risk for cancer and recommends changes when the client states she

eats red meat such as steaks or hamburgers every day

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 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."

When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply.

Hyperkalemia Hyperuricemia Hyperphosphatemia

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 stem cell transplant?

Monitor the client closely to prevent infection.

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

Slower-growing tissues at rest (muscle) are more radioresistant. Tumors that are well oxygenated are more sensitive to radiation. Tumors that are small in size and dividing rapidly are more sensitive.

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

Adjuvant therapy is likely.

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?

An aunt and uncle diagnosed with cancer

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?

Anticipatory grieving

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 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

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

Control

A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?

Extravasation

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

Extravasation

You are the nurse caring for a client with cancer. The client complains of pain and nausea. When assessed, you note that the client appears fearful. What other factor must you consider when a client with cancer indicates signs of pain, nausea, and fear?

Fatigue

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?

Graft-versus-host disease

A client diagnosed with cancer has their tumor staged and graded based on what?

How they tend to grow and the cell type

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.

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

Cancer has many characteristics. What is one of the most discouraging characteristics of cancer?

Metastasis

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 client with cancer stage T4,N3,M1 is ordered morphine sulfate 4 mg, subcutaneous every 3 to 4 hours. Two hours after the last injection, the client rings the call bell to report a pain scale of 9. Which is the appropriate action by the nurse?

Notify the physician of the breakthrough pain in an attempt to obtain additional orders.

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

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?

Sun safety and use of sunscreen

The physician is attending to a 72-year-old patient with a malignant brain tumor. The physician recommends immediate radiation therapy. Which of the following is a reason for the physician's recommendation?

To prevent the formation of new cancer cells

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 temporary."

A client with advanced cancer makes the following comment to the nurse: "Why are you bathing me? I am going to die no matter what." What is the most appropriate response of the nurse?

"Would you like to talk about what you are feeling?"

While doing a health history, a client tells you that her mother, grandmother, and sister died of 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."

During a client's examination and consultation, the physician keeps telling the client,"You have an abdominal neoplasm." Which of the following statements accurately paraphrases the physician's statement? Select all that apply.

"You have a new growth of abnormal tissue in your abdomen."

A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?

Indigestion

Which of the following is a type of procedure that uses liquid nitrogen to freeze tissue that causes cell destruction?

Cryosurgery

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."

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?

"I'll use hats to protect my head from the sun when my hair falls out."

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

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.

Which of the following would be consistent with a benign neoplasm?

Usually progressive and slow

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

Weight gain