Management of Patients with Oncologic Disorders (15) PrepU
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? Random, rapid growth of the tumor Cells colonizing to distant body parts Tumor pressure against normal tissues Emission of abnormal proteins
Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.
A nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching? 24 hours 2 to 4 days 7 to 14 days 21 to 28 days
Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
Which of the following is generally NOT considered to be a carcinogen? Parasites Viruses Dietary substances Defective genes
Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.
Interleukins (ILs)
ILs are cytokines produced by subsets of T-cell lymphocytes, natural killer cells, and dendritic cells (cells that present antigens to the immune system). Similar to IFNs, ILs have immunomodulatory effects on other components of the immune response. IL-2 has been approved by the U.S. Food and Drug Administration (FDA) as a treatment option for renal cell cancer and metastatic melanoma in adults. However, because toxicities may be severe and life life-threatening, the role of ILs as cancer treatment has been limited
1500 cells/mm3
If ANC below ___ risk for infection rises!!!!
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
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.
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 gender age
Correct response: dietary substances environmental factors viruses Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.
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's toilet patterns. Monitor the client to prevent sepsis. Monitor the client's physical condition. Monitor the client's heart rate.
Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.
Which class of antineoplastic agents is cell cycle-specific? Antimetabolites (5-FU) Antitumor antibiotics (bleomycin) Alkylating agents (cisplatin) Nitrosoureas (carmustine)
Antimetabolites are cell cycle-specific (S phase). Antitumor antibiotics, alkylating agents, and nitrosoureas are cell cycle-nonspecific.
Normal WBC count
5,000-10,000/mm3
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." "I use an electric razor to shave." "I take a stool softener every morning." "I removed all the throw rugs from the house."
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
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
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.
Which of the following would be inconsistent as a common side effect of chemotherapy? Weight gain Alopecia Myelosuppression Fatigue
Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.
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." "I am so glad the doctor was able to remove the entire tumor." "I will be glad to finally be done with treatments for this thing." "Thank goodness the tumor is contained and curable."
Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.
During a client's examination and consultation, the physician keeps telling the client,"You have an abdominal neoplasm." Which statements accurately paraphrase the physician's statement? Select all that apply. "You have a new growth of abnormal tissue in your abdomen." "You have an abdominal tumor." "You have an abdominal malignancy." "You have abdominal cancer."
New growths of abnormal tissue are called "tumors." Tumors may be benign or malignant; not all tumors are cancerous.
The drug interleukin-2 is an example of which type of biologic response modifier? Cytokine Monoclonal antibodies Retinoids Antimetabolites
Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.
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. Place a chair next to the bed to allow the spouse to sit. Have visitors wear dosimeters for safety. Allow visitors to telephone only.
Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.
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." "If I get nauseous, I'll try to eat several small, bland meals each day." "I'll allow myself plenty of time to rest between activities." "Most of the adverse effects should go away shortly after my last radiation treatment."
The client requires additional teaching if he mentions that he will lose the hair on his head as a result of radiation therapy. Alopecia is an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of his lungs, not his head. Nausea and fatigue are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete.
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 stimulates the immune system against the tumor cells. It treats drug-related anemia. It prevents alopecia. It lowers serum and uric acid levels.
The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurence can be reduced with allopurinol's action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure. Allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia.
nadir
lowest point of ANC following chemo
A decrease in circulating white blood cells is granulocytopenia. thrombocytopenia. leukopenia. neutropenia.
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 teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend? Low-fat hot dogs Smoked ham Oranges Medium-rare steak
A diet high in vitamin C and citrus may help reduce the risk of certain cancers, such as stomach and esophageal cancers. Hot dogs and smoked and cured foods are high in nitrates, which may be linked to esophageal and gastric cancers. Steak is a high-fat food that may increase the risk of breast, colon, and prostate cancers.
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." "Benign tumors grow very rapidly." "Benign tumors can spread from one place to another." "Benign tumors invade surrounding tissue."
Benign tumors remain at their site of development. They may grow large, but their growth rate is slower than that of malignant tumors. They usually do not cause death unless their location impairs the function of a vital organ, such as the brain.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Extravasation Stomatitis Nausea and vomiting Bone pain
The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.
neutrophils
WBC function is often impaired in patients with cancer. Among the five types of WBCs, (neutrophils [granulocytes], lymphocytes, monocytes, basophils, and eosinophils), ___ serve as the body's primary initial defense against invading organisms. Comprising 60% to 70% of the body's WBCs, neutrophils act by engulfing and destroying infective organisms through phagocytosis. Both the total WBC count and the concentration of neutrophils are important in determining the patient's ability to fight infection. A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils.
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? Eggs and milk Fish and poultry Ham and bacon Green, leafy vegetables
Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats. Nitrates are added to cured meats, such as ham and bacon.
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)
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.
Which type of surgery is used in an attempt to relieve complications of cancer? Palliative Prophylactic Reconstructive Salvage
Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? No further treatment is indicated. Adjuvant therapy is likely. Palliative care is likely. Repeat biopsy is needed before treatment begins.
T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs.The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? "I'll wash my skin with mild soap and water only." "I'll not use my heating pad during my treatment." "I'll wear protective clothing when outside." "I'm worried I'll expose my family members to radiation."
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 presenting a class on cancer for a local community group. You inform the attendees that chemical agents in the environment are believed to account for 75% of all cancers. Which organs are most susceptible to cancer caused by these chemical agents? Bone, breast, and thyroid Prostate, colon, and breast Eyes, breast, and prostrate Lungs, liver, and kidneys
The lungs, liver, and kidneys are affected mostly because they are involved with biotransformation and excretion of chemicals.
A patient is scheduled for cryoablation 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 medication to inject the area." "The surgeon is going to use liquid nitrogen to freeze the area." "The surgeon is going to use a laser to remove the area." "The sugeon is going to use radiofrequency to ablate the area."
Cryoablation is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers. Chemosurgery is the use of medication. Laser surgery is the use of a laser. Radiofrequency ablation is the use of thermal energy.
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 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.
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? Time, distance, and shielding The use of disposable utensils and wash cloths Avoid showering or washing over skin markings. Inspect the skin frequently.
Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.
Your patient is receiving carmustine, a chemotherapy agent. A significant side effect of this medication is thrombocytopenia. What symptom would the nurse assess for in a patient at risk for thrombocytopenia? Interrupted sleep pattern Hot flashes Nose bleed Increased weight
Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. A priority goal for this patient is to prevent trauma related to decreased platelet count. A soft toothbrush or an electric razor can be used. No invasive procedures should be performed. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.
TNM system
T- tumor spread N- node involvement M- presence of distant metastasis x = cannt be assessed 0=no evidence 1/2/3/4=size, metasasis, involvment of lymp nodes
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
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.
A patient with a diagnosis of renal cell carcinoma is being treated with chemotherapy. During a previous round of chemotherapy, the patient's tumor responded well to treatment but the chemotherapy caused intense nausea and vomiting. How should the patient's potential nausea and vomiting be addressed during this current round of treatment? Prioritize nonpharmacological treatments over medications Administer antiemetics in anticipation of the patient's nausea. Provide the patient with antiemetics at his first complaint of nausea. Administer antiemetics if the patient vomits or believes he will soon vomit.
The prevention of chemotherapy-induced nausea and vomiting is a priority. It is inappropriate to reject pharmacological treatments or to wait until the patient experiences nausea and/or vomiting before providing medication.
The nurse evaluates teaching as effective when a female client states that she will Use sunscreen when outdoors. Decrease tobacco smoking from one pack/day to half a pack/day. Exercise 30 minutes 3 times each week. Obtain a cancer history from her parents.
Use of sunscreens play a role in the amount of exposure to ultraviolet light. Even decreasing the use of tobacco still exposes a person to risk of cancer. The American Cancer Society recommends adults to engage in at least 30 minutes of moderate to vigorous physical activity on 5 or more days each week. It is recommended to obtain a cancer history from at least three generations.
Interferons (IFNs)
are cytokines with antiviral, antitumor, and immunomodulatory (inhibition or stimulation of the immune system) properties. Multiple antitumor effects of IFNs include antiangiogenesis, direct destruction of tumor cells, inhibition of growth factors, and disruption of the cell cycle (Weber, 2014). IFNs are used on a limited basis for the treatment of some solid and hematologic cancers. IFNs have been associated with significant toxicities, which have restricted their use and prompted clinicians to seek alternative therapies
cytokines
substances produced primarily by cells of the immune system to enhance or suppress the production and functioning of components of the immune system, are used to treat cancer or the adverse effects of some cancer treatments.
The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? Eat wholesome meals. Avoid spicy and fatty foods. Avoid intake of fluids. Eat warm or hot foods.
The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.
A client reports a new onset of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. The health care provider orders a diagnostic workup, which reveals end-stage gallbladder cancer. What nursing intervention should be used to facilitate adaptive coping? Refer client for professional counseling. Encourage ventilation of negative feelings. Assist with self-care activities of daily living. Provide written education for prescribed treatments.
Referring the client for professional counseling will faciliate adaptive coping. Encouraging ventilation of negative feelings will allow for emotional expression, but may not facilitate coping. Physical well-being will increase self-esteem, but won't necessarily help the patient cope with the diagnosis. Providing written education is for client teaching, not to facilitate coping.
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 treatment
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.
Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? Family history Drug history Blood studies Allergy history
Before the HSCT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before an HSCT procedure, the nurse need not evaluate client's family, drug, or allergy history.
The nurse is working with a client who has had an allohematopoietic 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: nadir. graft-versus-host disease. metastasis. acute leukopenia.
Graft-versus-host disease is a major cause of morbidity and mortality in clients who have had allogeneic transplant. Clinical manifestations of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent diarrhea, abdominal pain, and hepatomegaly.
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."
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.
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? Diagnostic Palliative Prophylactic Reconstructive
Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk of developing cancer. When surgical cure is not possible, the goals of surgical interventions are to relieve symptoms, make the patient as comfortable as possible, and promote quality of life as defined by the patient and family. Palliative surgery and other interventions are performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusions (Table 15-6). Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Diagnostic surgery, or biopsy, is performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant.
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. Maintain as much distance as possible from the patient while in the room. Alert family members that they should restrict their visiting to 5 minutes at any one time. Wear a lead apron when providing direct patient care
When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source.
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 allows time for you to cope with the treatment." "It will allow time for the repair of healthy tissue." "It will decrease the incidence of leukopenia and thrombocytopenia." "It is not really understood why you have to go for 6 weeks of treatment."
In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? Serving small portions of bland food Encouraging rhythmic breathing exercises Administering metoclopramide and dexamethasone as ordered Withholding fluids for the first 4 to 6 hours after chemotherapy administration
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.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? Administering aspirin if the temperature exceeds 102° F (38.8° C) Inspecting the skin for petechiae once every shift Providing for frequent rest periods Placing the client in strict isolation
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 caring for a client who has had a nuclear scan to aid in the diagnosis of possible cancer. The scan showed a "hot spot". What does this mean? An area of increased concentrations of the tracer used in the scan. Distinguishes areas of tissue that are normal. An area of decreased concentrations of the tracer used in the scan. Distinguishes abnormal areas of tumor
Nuclear Scans: Clients ingest or receive intravenous (IV) radioisotopes (also known as tracers). After specific time intervals, images are taken of tissues that are affected by cancer or other diseases; the images distinguish tissues or portions of tissues that absorb more or less of the tracer. "Hot spots" show on an image of a tumor that has increased concentrations of the tracer, whereas "cold spots" can be the image of a tumor that has decreased concentration of the tracer. Options B, C, and D are incorrect information about hot spots.
A nurse is caring for a client with prostate cancer and assesses bleeding gums and hematuria. What serum indicator should the nurse relate the bleeding? lymphocyte count of 30% platelet count of 60,000/mm3 neutrophil count of 40% reticulocyte count of 1%
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.
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? No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Can't assess tumor or regional lymph nodes and no evidence of metastasis Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees 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.
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.
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.
The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client? Suppression of the bone marrow Enhance action of the chemotherapy Decrease the need for additional adjuvant therapies Shorten the period of neutropenia
Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.
