Oncology

A patient is receiving chemotherapy and has a low WBC count. What patient statement indicates the need for further teaching?

"Fresh fruits and vegetables will help me get better."

A patient is admitted with herpes zoster. The health care provider orders an antiviral medication to slow the progression of the virus. Which medication will the nurse administer?

acyclovir (Zovirax)

An African American patient is seen with impending shock after an accident. How would the nurse expect the skin to appear during the assessment of the patient?

Ashen, gray, or dull

A patient has terminal lung cancer and reports constant pain. To maintain optimal pain control, when should analgesics be administered? (Select all that apply.)

At scheduled intervals

A patient states that he has basal cell carcinoma and is going to die. When planning the best response to make, the nurse should include what knowledge?

Basal cell carcinoma is rarely terminal.

A 42-year-old patient has palpated a small lump in her left breast during her monthly BSE. She has scheduled an appointment with her health care provider. Which test will be used to make a definite diagnosis of a benign or malignant tumor of her breast?

Biopsy

A 61-year-old patient is receiving chemotherapy. The patient becomes anemic and has petechiae and ecchymoses scattered over her upper trunk, especially her arms. What side effect is the patient experiencing?

Bone marrow suppression

Identify the top three most common types of cancer in women.

Breasts, lungs, colorectal

The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?

Calcium level

A 58-year-old patient with colon cancer is receiving combined radiation therapy and chemotherapy. He has developed diarrhea. The patient asks the nurse why he is now having diarrhea. What nursing response is most accurate?

"Radiation is very irritating to the lining of your GI tract, which has caused diarrhea."

A 24-year-old patient has been receiving chemotherapy for acute lymphoblastic leukemia and has developed leukopenia. Which patient statement indicates that he understands discharge teaching concerning leukopenia? (Select all that apply.)

**"I should avoid close contact with people who might give me an infection." **"I should avoid being in large crowds until my white blood cell count raises to an acceptable level."

The nurse provides skin care instructions to the client who is receiving external radiation therapy. Which statement by the client indicates the need for further teaching ? Select all that apply.

**"I will limit sun exposure to 1 hour daily." **"I will apply moisturizer with a cotton tipped applicator for itching. "

Before the insertion of a cervical implant, the nurse tells the patient what to expect while it is in place. Which statement is accurate? (Select all that apply.)

**"Nurses will always be available, but they will spend only a short time at your bedside." **"Visitors will be limited during the time you are being treated with the internal radiation therapy."

Discuss the prevalence of cancer in the United States.

**1 in 2 men and 1 in 3 women will develop cancer in their lifetime **39% of women and men living in the United States will be diagnosed with at some point in their lifetime **Of every five deaths in the United States, one is from cancer, which makes cancer the second leading cause of death, after heart disease

The nurse is assisting with conducting a health-promotion program to community members regarding testicular cancer. The nurse determines that further teaching is needed if a community member states that which is a sign/symptom of testicular cancer? Select all that apply

**Alopecia **Elevation in prostate specific antigen (PSA) levels

The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further teaching if the client states an intention to take which action? Select all that apply.

**Apply pressure on the radiated area to prevent bleeding. **Avoid standing within 6 feet of persons under the age of 18 years.

It is important to teach a patient the warning signs of skin cancer. Which characteristic(s) of a nevus is a warning sign of skin cancer? (Select all that apply.)

**Border irregularity **Delayed or prolonged lesional healing

The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? Select all that apply .

**Chest x-ray **Pulmonary function studies

Eight warning signs of cancer

1. Changes in bowel or bladder habits. 2. Sores that don't heal 3. White patches inside the mouth or on the tongue. 4. Unusual bleeding or discharge. 5. Thickening or lump in breast or elsewhere. 6. Indigestion or difficulty swallowing. 7. Recent changes in warts, moles, or skin. 8. Nagging cough or hoarseness.

Discuss the steps involved in performing breast self-examinations.

2-3 days after menstrual period ends.

When reinforcing teaching about signs and symptoms of ovarian cancer with a community group of women, the nurse emphasizes which sign/symptom as being a typical manifestation of the disease recognized by persons diagnosed with the condition?

Abdominal distention or fullness

Malignant

Abnormal cell growth with a loss of normal role and function. Recurs, progressive, and can metastasize.

The health care provider has scheduled a débridement for a patient who has partial-thickness burns on his chest and right upper leg. Which nursing intervention is most important?

Administer an opioid analgesic intravenously before the débridement.

Identify those at high risk for prostate cancer.

African American and men who have a positive family history.

When should PSA/rectal examination begin if a person is at high risk for prostate cancer?

Age 40

Discuss the age when PSA/rectal examination should begin.

Age 40 if family history, otherwise age 50

Discuss how heavy consumption of alcohol may increase the risk of cancer.

Alcohol use is linked to cancers of the mouth, larynx, pharynx, esophagus, colorectum, breast, and liver. The risk increases significantly when consuming more than 2 drinks per day.

The nurse is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication that may become a chronic problem related to the surgery?

Arm edema on the operative side

Identify clinical manifestations of testicular cancer.

Lump or enlargement of either testicle, a heavy feeling in the scrotum, dull aching in either the groin or the lower abdomen, fluid collection in the scrotum, and tenderness or enlargement of the breasts (this results from hormones produced by cancer cells).

Identify the leading cause of cancer related death in both men and women.

Lung Cancer

A patient has a vaginal radiation implant in place. What nursing intervention should be added to the patient's plan of care?

Monitor vital signs every 4 hours and report temperature higher than 100°F.

Which method of assessing burn size applies only to adults?

Rule of nines

Identify the most preventable cause of lung cancer.

Smoking

A parent tells the dermatologist that her daughter seems to be losing interest in school. Which medication could have caused the patient's change in behavior?

isotretinoin

Discuss the meaning of M₁-M₄.

Distant metastasis present, specific site(s)

A patient tells the nurse she has not gone out of the house for weeks because she could not cover the lesions on her face with makeup. What would be an appropriate patient problem?

Distorted Body Image, related to change in personal appearance

Discuss what should be included in education regarding the balanced diet to prevent cancer.

Eat a balanced diet that includes green, deep yellow, and orange vegetables; cruciferous vegetables (cabbage, broccoli, cauliflower, and Brussels sprouts); fresh fruits; allium vegetables (onion and garlic); nuts; legumes; soy products; whole grains; and adequate amounts of fiber. Reduce the amount of fat and preservatives, including smoked and salt-cured meats. Limit the consumption of processed foods and red meats.

Multiple myeloma can cause hypercalcemia due to bone destruction. What intervention is needed to prevent kidney stones?

Encourage consumption of at least 2L of fluid per day to offset potential problems with hypercalcemia

Identify the contributing factor in one third of the cancer in the U.S.

Dietary habits: Nutrition is suspected to be a contributing factor. Diets that are high in fat and low in fiber, as well as inadequate nutrient intake, are associated with cancer development.

Clinical Staging 0

Cancer in situ

What should be included in the assessment of a patient with an electrical burn?

Cardiac irregularities

According to the American Cancer Society, what would have the greatest influence in reducing the risk of lung cancer?

Cessation of smoking

A patient is admitted with partial- and full-thickness burns on his right lower extremity. What is likely to be included in the plan of care initially?

Closed dressing change every 3 hours

Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that which is the primary action of this medication?

Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

Identify the objective finding expected of Hodgkin's cancer during assessment.

Enlarged lymph nodes

Discuss the recommendations to include in education for exercise to prevent cancer.

Exercise regularly. The American Cancer Society recommends that adults engage in at least 150 minutes of moderate physical activity or 75 minutes of vigorous activity each week

Clinical Staging 3

Extensive local and regional spread.

The client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which adverse effect is specific to this medication?

Extremity numbness

A patient complains of a burning pain on his lower thoracic area. On inspection, the area is found to be erythematous and edematous with a cluster of vesicles. What condition is most likely to be diagnosed?

Herpes zoster

Which of the following assessments should the nurse report to the health care provider immediately for an adult patient with partial-thickness burns over 25% of his body?

Hourly urinary output of 10 to 15 mL

Clinical Staging 2

Limited local spread

Benign

Not recurrent or progressive, does not spread.

Discuss the frequency at which PSA/rectal examination should be performed.

Once per year

The client with small cell lung cancer is being treated with etoposide and the nurse is assisting with caring for the client during administration. The client gets up to use the bathroom and is dizzy and very weak. The nurse understands these symptoms are likely as a result of which side/adverse effect that is specifically associated with this medication?

Orthostatic hypotension

Identify the most common factor in the development of basal and squamous cell skin cancers and melanoma.

Over exposure to Ultraviolet Radiation, chronic skin irritations, and genetic predisposition.

The patient has been diagnosed with terminal cancer. Which of the following is the most therapeutic approach by the nurse?

Pain is what the patient says it is.

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which is documented in the client's history?

Pancreatitis

The client is hospitalized for the insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. Which is the immediate nursing action?

Pick up the implant with long-handled forceps and place into a lead container.

A patient has a rash on her back that began about 10 days ago with a raised, scaly border and a pink center. Now she has similar eruptions on both sides of her back. With what condition are these manifestations most consistent?

Pityriasis rosea

A 63-year-old patient has a diagnosis of cancer of the prostate gland with metastasis and is experiencing cachexia. How is cachexia best described?

Poor health, malnutrition, weakness, and emaciation

A patient has a history of oat cell carcinoma of the lung and is being treated with chemotherapy. His WBC count is 2.5/mm 3 . What is the nurse's primary concern?

Prevention of infection

Identify the top three most common types of cancer in men.

Prostate, lungs, colon, and rectum.

Discuss TNM Cancer Staging Classification System.

Represents the standardization of the clinical staging of cancer. Used to determine the extent of the disease process of cancer according to three parameters: Tumor size (T), degree of regional spread to the lymph nodes (N), and metastasis (M).

A patient is admitted with partial-thickness burns on his upper chest and face. What is the most important thing for the nurse to monitor in the patient on admission?

Respiratory problems

A patient has an inhalation burn injury. Which is a medical emergency?

Respiratory stridor

The nurse planning the care for a patient who has impetigo expects to administer which topical drug to the patient?

Retapamulin

Discuss the meaning of T₁ - T₄.

Size and/or extent of the primary tumor

The nurse educator is discussing the importance of the reduction of carcinogens in primary prevention of cancer. Which risk factor is considered significant in many types of cancer?

Smoking

Identify environmental and chemical carcinogens.

Some of these include fumes from rubber and chlorine and dust from cotton, coal, nickel, chromate, asbestos, and vinyl chloride.

A patient with thermal burns over 30% of his body has maintained a urinary output of 250 mL for the past 8 hours. What can the nurse infer from this information?

Stage of hypovolemic burn shock is resolving

Discuss immunosurveillance.

The immune systems recognition and destruction of newly developed abnormal cells.

The nurse is caring for a patient with an open skin lesion. Which patient goal is the highest priority?

The patient does not develop an infection of the lesion.

An adolescent patient is seen in the clinic with a mild case of acne. What does the nurse expect to assess?

The patient reports a sense of low self-esteem.

Define Carcinogenesis.

The process by which normal cells are transformed into cancer cells. Cancer may be caused by external factors such as infection, chemicals, radiation, and tobacco use and internal factors such as genetic mutations, immunologic conditions, and hormones

Which is true regarding cancer prevention and health care promotion behaviors for patients with a diagnosis of cancer?

They are increasingly important with the growing population of cancer survivors.

The health care provider has ordered oral griseofulvin for tinea capitis. The patient's mother asks the nurse why an oral medication is used rather than a cream. What information should be provided by the nurse?

Topical creams do not reach the root of the hair to kill the fungus.

Clinical Staging 1

Tumor limited to the tissue of origin; localized tumor growth

The client with acute myelocytic leukemia is being treated with busulfan. Which laboratory value should the nurse specifically monitor during treatment with this medication?

Uric acid level

When teaching a patient to care for herpes zoster lesions at home, which is the most important instruction for the nurse to provide?

Wash hands before and after applying medication.

The patient is receiving chemotherapy and has the patient problem of Insufficient Nutrition. What are likely reasons for this lack of nutrition? (Select all that apply.)

**The patient has developed diarrhea. **The patient has been having experiencing episodes of choking during meals.

A patient has been diagnosed with scabies. What does the nurse anticipate to assess with this patient? (Select all that apply.)

**Wavy brown lines on the skin **Nocturnal pruritus

When teaching home care to a patient with recurrent genital herpes infection, it is important to include which information? (Select all that apply.)

**The patient will need to use protection even when no lesions are evident. **Precautions for delivery must be made in the event of becoming pregnant.

The nurse is assisting with caring for a client with cancer who is receiving cisplatin. Which adverse effects are associated with this medication? Select all that apply.

**Tinnitus **Ototoxicity **Nephrotoxicity **Hypomagnesemia

A patient has received a diagnosis of stage I breast cancer. She is receiving adjuvant chemotherapy and radiation therapy after a lumpectomy. What teaching point should be included in this patient's plan of care? (Select all that apply.)

**Chemotherapy-related hair loss is usually temporary. **Avoid the use of lotions on the skin at and near the site of radiation treatment

The nurse is assisting with developing a plan of care for the client with multiple myeloma. Which nursing intervention should be included to prevent renal failure for this client? Select all that apply.

**Encouraging fluids **Monitoring serum calcium and uric acid levels

The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which signs and symptoms of the client are associated with Hodgkin's disease? Select all that apply.

**Fatigue **Weakness **Night sweats **Enlarged lymph nodes

The client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. Besides treatment of the lung cancer, the nurse anticipates that which interventions may be prescribed to treat the SIADH? Select all that apply.

**Institute safety measures **Frequent monitoring of sodium blood levels **Gather data about the neurological status frequently **Medication that is antagonistic to antidiuretic hormone (ADH)

The nurse is reviewing the history for a patient who has been admitted with cellulitis. Which condition(s) would predispose the patient to cellulitis? ( Select all that apply.)

**Malnutrition **Treatment with chemotherapy **Venous insufficiency of the lower legs **Diabetes mellitus

The nurse is reviewing the laboratory results of a client who is receiving chemotherapy and notes that the platelet count is 10,000 mm 3 (10 × 10 9 /L). On the basis of this laboratory value, the nurse should perform which intervention? Select all that apply .

**Monitor stools for occult blood. **Instruct the client not to bend over at the waist or lift. **Instruct the client to blow nose very gently without blocking either nostril.

The nurse just finished an assessment for a patient with systemic lupus erythematosus (SLE). Which clinical manifestation would the nurse expect to find? (Select all that apply.)

**Oral ulcers **Erythematous rash over the nose and cheeks

The nurse is caring for a client with an internal radiation implant. The nurse should observe which principle? Select all that apply.

**Pregnant women are not allowed into the client's room. **Wear a lead apron while delivering bedside care to the client.

Malignant Tumors description

**Rate of growth varies; usually rapid **Metastasizes **Rarely contained within a capsule **Irregular; more immobile when palpated **Little resemblance **Invades normal tissue **May recur after removal. **Fatal without treatment

The nurse is assisting with creating a plan of care for a client with pancytopenia as a result of chemotherapy. The nurse should suggest including which in the plan of care? Select all that apply.

**Restricting fresh fruits and vegetables in the diet **Applying a face mask to the client if outside the client room.

The licensed practical nurse (LPN) is assisting the registered nurse (RN) to create a teaching plan for the client receiving an antineoplastic medication. The LPN expects which information to be included? Select all that apply.

**Rinse mouth after meals and use a soft toothbrush. **Maintain oral hygiene and inspect the mouth for sores daily. **Consult with primary health care provider (PHCP) before receiving immunizations.

Benign Tumors description

**Slow, steady growth **Remains localized **Usually contained within a capsule **Smooth, well defined; movable when palpated **Resembles parent tissue **Crowds normal tissue **Rarely recurs **Rarely fatal

The client is receiving external radiation to the neck for cancer of the larynx. The nurse monitors the client knowing that which are side/adverse effects of the external radiation? Select all that apply.

**Sore throat **Red and dry skin over neck

The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a suprapubic prostatectomy. The nurse should reinforce which discharge instruction? Select all that apply.

**Take the prescribed stool softener every day. **Avoid lifting objects heavier than 20 pounds for 6 weeks.

Discuss when to seek medical care regarding suspected cancer.

If you notice a change in what is normal for you and if cancer is suspected. Early detection of cancer has a positive effect on prognosis.

The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding is indicative of the massive cell destruction that occurs with the chemotherapy?

Increased uric acid level

The nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling. The nurse should take which appropriate action?

Notify the registered nurse immediately.