Prep-U Ch. 18 Caring for Clients with Cancer

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? A. Diagnostic B. Palliative C. Prophylactic D. Reconstructive

C. Prophylactic - 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 decrease in circulating white blood cells (WBCs) is referred to as A. Granulocytopenia B. Thrombocytopenia C. Leukopenia D. Neutropenia

C. Leukopenia - 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 client who is receiving chemotherapy for esophageal cancer complains of "feeling sick to my stomach all the time." What is the best suggestion the nurse can make to help alleviate this client's nausea? A. Eat low-fat foods. B. Consume warm or hot foods. C. Drink more soft drinks. D. Consume more salty foods.

A. Eat low-fat foods. - Side effects of cancer and cancer therapies can devastate the client's ability to eat, which may change daily or as often as with each meal. Clients with nausea fare better with low-fat foods and "dry" meals (taking liquids between meals). Clients who are nauseated are better able to tolerate cold foods and beverages. Clients should limit soft drinks, which are high in empty calories. Salty items may aggravate mouth sores.

A client has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The client states that he is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic? A. "Smoking is the reason you are here." B. "The doctor left orders for you not to smoke." C. "You are anxious about the surgery. Do you see smoking as helping?" D. "Smoking is OK right now, but after your surgery it is contraindicated."

C. "You are anxious about the surgery. Do you see smoking as helping?" - Stating "You are anxious about the surgery. Do you see smoking as helping?" acknowledges the client's feelings and encourages him to assess his previous behavior. Saying "Smoking is the reason you are here" belittles the client. Citing the doctor's orders does not address the client's anxiety. Giving approval for smoking would be highly detrimental to this client.

A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem? A. The patient requests that her family bring her makeup and wig. B. The patient begins to discuss the future with her family. C. The patient reports less disruption from pain and discomfort. D. The patient cries openly when discussing her disease.

A. The patient requests that her family bring her makeup and wig. - Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they don't assess improved body image and self-esteem.

A client has been diagnosed with a neoplasm and is seeking further information and possible treatment. The primary care physician described the neoplasm as "insidious." What does the word "insidious" mean? A. slow-growing B. life-threatening C. aggressive D. terminal

A. slow-growing - Cancer is insidious (slow growing).

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? A. uses the treadmill for 30 minutes on 5 days each week B. eats red meat such as steaks or hamburgers every day C. works as a secretary at a medical radiation treatment center D. drinks one glass of wine at dinner each night

B. eats red meat such as steaks or hamburgers every day - Dietary substances such as nitrate-containing and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. Alcohol consumption recommendations include drink no more than one drink per day for women or two per day for men.

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? A. Erythema B. Flare C. Extravasation D. Thrombosis

C. Extravasation - The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.

What nursing action best demonstrates primary cancer prevention? A. Encouraging yearly Pap tests B. Teaching testicular self-examination C. Teaching clients to wear sunscreen D. Facilitating screening mammograms

C. Teaching clients to wear sunscreen - Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.

Chemotherapeutic agents have which effect associated with the renal system? A. Hypokalemia B. Increased uric acid excretion C. Hypophosphatemia D. Hypercalcemia

B. Increased uric acid excretion - Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Urinary excretion of uric acid increases with the use of chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.

A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A. Liver function tests (LFTs) B. Complete blood count (CBC) C. Platelet count D. Blood urea nitrogen and creatinine

A. Liver function tests (LFTs) - Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.

An oncology client has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis? A. Apply an ice pack or heating pad PRN to relieve pain and pruritis B. Avoid skin contact with water whenever possible C. Apply phototherapy PRN D. Avoid rubbing or scratching the affected area

D. Avoid rubbing or scratching the affected area - Rubbing and or scratching will lead to additional skin irritation, damage, and increased risk of infection. Extremes of hot, cold, and light should be avoided. There is no need to avoid contact with water.

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? A. It stimulates the immune system against the tumor cells. B. It treats drug-related anemia. C. It prevents alopecia. D. It lowers serum and uric acid levels.

D. It lowers serum and uric acid levels. - The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurrence 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.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? A. Promotion B. Initiation C. Prolongation D. Progression

D. Progression - Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.

The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client? A. "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results." B. "These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer." C. "Try not to be concerned about these symptoms. Every client feels this way after having radiation therapy." D. "Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying."

A. "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results." - Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the client and should not be belittled. Radiation destroys both cancerous and normal cells.

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? A. Avoiding using soap on the irradiated areas B. Applying talcum powder to the irradiated areas daily after bathing C. Wearing a lead apron during direct contact with the client D. Removing thoracic skin markings after each radiation treatment

A. Avoiding using soap on the irradiated areas - Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.

The drug interleukin-2 is an example of which type of biologic response modifier? A. Cytokine B. Monoclonal antibodies C. Retinoids D. Antimetabolites

A. Cytokine - 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.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? A. Encourage fluid intake to dilute the urine. B. Take measures to acidify the urine and prevent uric acid crystallization. C. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. D. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

A. Encourage fluid intake to dilute the urine. - The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage.

An oncology nurse educator is providing health education to a client who has been diagnosed with skin cancer. The client's wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite? A. Malignant cells possess greater mobility than normal body cells. B. Malignant cells contain proteins called tumor-associated antigens. C. Chromosomes contained in cancer cells are more durable and stable than those of normal cells. D. The nuclei of cancer cells are unusually large, but regularly shaped.

B. Malignant cells contain proteins called tumor-associated antigens. - The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-associated antigens. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism), though they are not always mobile. Fragility of chromosomes is commonly found when cancer cells are analyzed.

The nurse is conducting a health education about cancer prevention to a group of adults. What menu best demonstrates dietary choices for potentially reducing the risks of cancer? A. Smoked salmon and green beans B. Pork chops and fried green tomatoes C. Baked apricot chicken and steamed broccoli D. Liver, onions, and steamed peas

C. Baked apricot chicken and steamed broccoli - Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited.

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? A. Eggs and milk B. Fish and poultry C. Ham and bacon D. Green, leafy vegetables

C. Ham and bacon - 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 undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean? A. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis B. Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis C. Can't assess tumor or regional lymph nodes and no evidence of metastasis D. Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis

B. Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis - Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.

A client with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. What mechanism of action do antimetabolites interferes with? A. cell division or mitosis during the M phase of the cell cycle B. normal cellular processes during the S phase of the cell cycle C. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific) D. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle-nonspecific)

B. normal cellular processes during the S phase of the cell cycle - Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

A nurse provides care on a bone marrow transplant unit and is preparing a female client for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the client's family and friends? A. "Your family should likely gather at the bedside in case there's a negative outcome." B. "Make sure she doesn't eat any food in the 24 hours before the procedure." C. "Wear a hospital gown when you go into the client's room." D. "Do not visit if you've had a recent infection."

D. "Do not visit if you've had a recent infection." - Before HSCT, clients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the client's contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching? A. "I'll wash my skin with mild soap and water only." B. "I'll not use my heating pad during my treatment." C. "I'll wear protective clothing when outside." D. "I'm worried I'll expose my family members to radiation."

D. "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.

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? A. Promoting the synthesis and release of leukocytes B. Focusing the client's immune system exclusively on the tumor C. Potentiating the effects of chemotherapeutic agents and radiation therapy D. Altering the immunologic relationship between the tumor and the client

D. Altering the immunologic relationship between the tumor and the client - BRMs alter the immunologic relationship between the tumor and the cancer client (host) to provide a therapeutic benefit. They do not necessarily increase white cell production or focus the immune system solely on the tumor. BRMs do not potentiate radiotherapy and chemotherapy.