Prep U: Chapter 12: Oncologic Management
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? Undifferentiated cells Causes generalized symptoms Slow rate of growth Ability to invade other tissues
Slow rate of growth Explanation: Benign tumors have a slow rate of growth and well-differentiated cells. Benign tumors do not invade surrounding tissue and do not cause generalized symptoms unless the location of the tumor interferes with the functioning of vital organs.
A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? Have visitors wear dosimeters for safety. Allow visitors to telephone only. Place a chair next to the bed to allow the spouse to sit. Place the client in a private room.
Place the client in a private room. Explanation: 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.
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? "I'll wear protective clothing when outside." "I'm worried I'll expose my family members to radiation." "I'll wash my skin with mild soap and water only." "I'll not use my heating pad during my treatment."
"I'm worried I'll expose my family members to radiation." Explanation: 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.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Prolongation Promotion Initiation Progression
Progression Explanation: 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.
A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis? Rust-colored sputum Red, open sores on the oral mucosa Yellow tooth discoloration White, cottage cheese-like patches on the tongue
Red, open sores on the oral mucosa Explanation: The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.
The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? An aunt and uncle diagnosed with cancer 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 Explanation: 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.
The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? Avoid spicy and fatty foods. Eat warm or hot foods. Avoid intake of fluids. Eat wholesome meals.
Avoid spicy and fatty foods. Explanation: 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.
Which is a growth-based classification of tumors? Carcinoma Sarcoma Leukemia Malignancy
Malignancy Explanation: Tumors classified on the basis of growth are described as benign or malignant. Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias.
According to the tumor-node-metastasis (TNM) classification system, T0 means there is No distant metastasis No regional lymph node metastasis No evidence of primary tumor Distant metastasis
No evidence of primary tumor Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.
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 Sodium level of 142 mEq/L Serum potassium level of 2.6 mEq/L Blood pressure of 120/64 to 130/72 mm Hg
Serum potassium level of 2.6 mEq/L Explanation: 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.
The physician is attending to a client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? To analyze the lymph nodes involved To remove the tumor from the brain To prevent the formation of new cancer cells To destroy marginal tissues
To prevent the formation of new cancer cells Explanation: Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present; also, it can be used prophylactically to prevent spread. Biopsy is used to analyze lymph nodes or to destroy the surrounding tissues around the tumor.
The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following? A normal reaction to the diagnosis of cancer. A side effect of the neoplastic drugs. An aberrant psychologic reaction to the chemotherapy. A psychiatric diagnosis everyone has at one time or another.
A normal reaction to the diagnosis of cancer. Explanation: Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy lifestyle. They also may express anger related to the diagnosis and their inability to be in control. While depression is understandable, it also needs to be acknowledged and treated if necessary. Depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.
A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? Avoiding using soap on the irradiated areas Wearing a lead apron during direct contact with the client Applying talcum powder to the irradiated areas daily after bathing Removing thoracic skin markings after each radiation treatment
Avoiding using soap on the irradiated areas Explanation: 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 primary cancer treatment goal is prolonged survival and containment of cancer cell growth? Control Prevention Cure Palliation
Control Explanation: The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.
While administering an intravenous chemotherapeutic medication to a client, the nurse assesses swelling at the insertion site. What is the nurse's first action? Aspirate as much of the fluid as possible. Discontinue the intravenous medication. Administer a neutralizing solution. Apply a warm compress.
Discontinue the intravenous medication. Explanation: If extravasation of a chemotherapeutic medication is suspected, the nurse must immediately stop the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.
Which of the following would be inconsistent as a common side effect of chemotherapy? Myelosuppression Fatigue Alopecia Weight gain
Weight gain Explanation: Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.
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? The use of disposable utensils and wash cloths Time, distance, and shielding Inspect the skin frequently. Avoid showering or washing over skin markings.
Inspect the skin frequently. Explanation: 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.
In which phase of the cell cycle does cell division occur? G2 phase S phase Mitosis G1 phase
Mitosis Explanation: Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase.
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? uses the treadmill for 30 minutes on 5 days each week works as a secretary at a medical radiation treatment center eats red meat such as steaks or hamburgers every day drinks one glass of wine at dinner each night
eats red meat such as steaks or hamburgers every day Explanation: 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.
The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? It removes a wedge of tissue for diagnosis. It treats cancer with lymph node involvement. It is used to remove cancerous cells using a needle. It removes an entire lesion and the surrounding tissue.
It removes a wedge of tissue for diagnosis. Explanation: The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.
What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? It functions against disseminated disease. It targets normal body cells as well as cancer cells. It causes a systemic reaction. It attacks cancer cells during their vulnerable phase.
It targets normal body cells as well as cancer cells. Explanation: Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.
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? Encourage ventilation of negative feelings. Assist with self-care activities of daily living. Provide written education for prescribed treatments. Refer client for professional counseling.
Refer client for professional counseling. Explanation: Referring the client for professional counseling will facilitate 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 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 Ate 75% of all meals during the day Temperature of 98.3° F (36.8° C) White blood cell (WBC) count of 9,000 cells/mm3
Stage 3 pressure ulcer on the left heel Explanation: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.
The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." "I hope they find a bone marrow donor who matches." "The doctor will remove cells from my bone marrow before beginning chemotherapy." "I will need to attend follow-up visits for up to 3 months after treatment."
"I hope they find a bone marrow donor who matches." Explanation: An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months, but not in protective isolation.
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 continue having your menses every month." "You will experience menopause now." "You will be unable to have children." "You will need to practice birth control measures."
"You will need to practice birth control measures." Explanation: Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.
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? Thrombosis Flare Erythema Extravasation
Extravasation Explanation: 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.
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 Places the client on oxygen by nasal cannula Gives prednisolone IV Stops the chemotherapeutic infusion Administers diphenhydramine
Stops the chemotherapeutic infusion Explanation: The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.
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? Pool and water safety Breast and testicular self-exams Hand washing and infection prevention Sun safety and use of sunscreen
Sun safety and use of sunscreen Explanation: Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? The client should consider getting a wig or cap prior to beginning treatment. The hair will grow back the same as it was before treatment. The hair will grow back within 2 months post therapy. Alopecia related to chemotherapy is relatively uncommon.
The client should consider getting a wig or cap prior to beginning treatment. Explanation: If hair loss is anticipated and causing the client anxiety, a wig, cap, or scarf should be purchased before therapy begins. Alopecia develops because chemotherapy affects the rapidly growing cells of the hair follicles. Hair usually begins to grow again within 4 to 6 months after therapy. Clients should know that new growth may have a slightly different color and texture.
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
Administering metoclopramide and dexamethasone as ordered Explanation: 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.
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
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Explanation: 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.
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 Placing the client in strict isolation Providing for frequent rest periods
Inspecting the skin for petechiae once every shift Explanation: 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 client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Bone pain Stomatitis Extravasation Nausea and vomiting
Extravasation Explanation: 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.
A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis? Recommend that the client discontinue chemotherapy. Provide a solution of viscous lidocaine for use as a mouth rinse. Monitor the client's platelet and leukocyte counts. Check regularly for signs and symptoms of stomatitis.
Provide a solution of viscous lidocaine for use as a mouth rinse. Explanation: To decrease the pain of stomatitis, the nurse should provide a solution of viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection, but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.
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: reinforcement of the client's medication regimen. signs and symptoms of infection. chemotherapy exposure and risk factors. expected chemotherapy-related adverse effects.
chemotherapy exposure and risk factors. Explanation: The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.
A nurse is planning caring for a client who has developed erythema following radiation therapy for a lesion on the left lower leg. Which intervention would the nurse include in the client's plan of care to best support skin recovery at the affected site? Select all that apply. Wear clothing that fits snugly Keep the area cleanly shaven Apply an emollient immediately before treatment Cleanse with lukewarm water and pat dry Periodically apply ice
Cleanse with lukewarm water and pat dry Explanation: Erythema is a term used to describe redness of body tissue. Care to the affected area must focus on preventing further skin irritation, drying, and damage; the client should cleanse the area with lukewarm water and mild, nondeodorant soap, and pat dry. Application of ice, shaving, and wearing tight fitting clothing over the area could further damage the already traumatized tissue. Emollients may be used as directed by the radiation oncologist to soothe and moisturize irritated skin. However, even approved emollients should not be used up to 4 hours before the treatment time.
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 can be given at lower doses. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. The second and third drugs increase the effectiveness of the first drug.
The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Explanation: Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.
A client diagnosed with cancer makes the following statement to the nurse: "I guess I will tell my health care provider 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. Clinical trials are opening up new cancer treatments all the time. Nausea and vomiting are only a factor for the first 24 hours after treatment. Most clients believe the discomfort is well worth the cure for cancer.
Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Explanation: Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but this does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.
A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? Monitor the client to prevent sepsis. Monitor the client's heart rate. Monitor the client's toilet patterns. Monitor the client's physical condition.
Monitor the client to prevent sepsis. Explanation: 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.
