PrepU Chapter 15: Oncology: Nursing Management in Cancer Care

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? 1. Avoiding using soap on the irradiated areas 2. Wearing a lead apron during direct contact with the client 3. Applying talcum powder to the irradiated areas daily after bathing 4. Removing thoracic skin markings after each radiation treatment

1

Which of the following is a term used to describe the process of programmed cell death? 1. Apoptosis 2. Mitosis 3. Angiogenesis 4. Carcinogenesis

1

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? 1. Control 2. Prevention 3. Palliation 4. Cure

1

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? 1. Allogeneic 2. Autologous 3. Homogenic 4. Syngeneic

1

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 1. "You will continue having your menses every month." 2. "You will need to practice birth control measures." 3. "You will experience menopause now." 4. "You will be unable to have children."

2

The nurse is caring for a patient undergoing an incisional biopsy. Which of the following statements does the nurse understand is true about an incisional biopsy? 1. It treats cancer with lymph node involvement. 2. It removes a wedge of tissue for diagnosis. 3. It removes an entire lesion and surrounding tissue. 4. It is used to remove the cancerous cells using a needle.

2

The nurse is conducting a screening for familial predisposition of cancer. Which of the following should the nurse note as a possible indication of hereditary cancer syndrome? 1. Onset of cancer after age 50 in family member 2. An aunt and uncle diagnosed with cancer 3. A second cousin diagnosed with cancer 4. A first cousin diagnosed with cancer

2

The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is: 1. cell-cycle specific in the S phase. 2. cell-cycle nonspecific. 3. cell-cycle specific in the P phase. 4. cell-cycle specific in the M phase.

2

You are teaching clients about cancer prevention and explain that the root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) as a result from multiple factors. You explain that which of the following are possible carcinogens? Select all that apply. 1. Gender 2. Dietary substances 3. Environmental factors 4. Viruses 5. Age

2, 3, 4

A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery? 1. "This surgery will prevent further tumor growth." 2. "Removing the tumor is a primary treatment for colon cancer." 3. "Once the tumor is removed, cell pathology can be determined." 4. "Tumor removal will promote comfort."

4

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? 1. Disturbed body image 2. Chronic low self-esteem 3. Impaired swallowing 4. Anticipatory grieving

4

A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis? 1. Yellow tooth discoloration 2. Rust-colored sputum 3. White, cottage cheese-like patches on the tongue 4. Red, open sores on the oral mucosa

4

A decrease in circulating white blood cells is 1. neutropenia. 2. granulocytopenia. 3. thrombocytopenia. 4. leukopenia.

4

In which phase of the cell cycle does cell division occur? 1. G1 phase 2. S phase 3. G2 phase 4. Mitosis

4

The client is receiving a vesicant anti neo plastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? 1. Stomatitis 2. Bone pain 3. Nausea and vomiting 4. Extra vasation

4

The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? 1. "New hair growth will return without any change to color or texture." 2. "Wigs can be used after the chemotherapy is completed." 3. "Clients with alopecia will have delay in grey hair." 4. "The hair loss is temporary."

4

Which of the following does a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? 1. Allergy history 2. Family history 3. Drug history 4. Blood studies

4

Which of the following is a term used to describe the process of programmed cell death? 1. Mitosis 2. Carcinogenesis 3. Apoptosis 4. Angiogenesis

3

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? 1. Clarify information provided by the physician. 2. Counsel the patient about the possibility of losing her breast. 3. Provide aseptic care to the incision postoperatively. 4. Provide time for the patient to discuss her concerns.

4

When caring for a client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? 1. Avoid showering or washing over skin markings. 2. Inspect the skin frequently. 3. Time, distance, and shielding 4. The use of disposable utensils and wash cloths

2

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? 1. Eat wholesome meals. 2. Avoid intake of fluids. 3. Avoid spicy and fatty foods. 4. Eat warm or hot foods.

3

A nurse is caring for a recently married, 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment? 1. "I'll only need chemotherapy treatment before receiving my bone marrow transplant." 2. "I'll have to remain in the hospital for about 3 months after my transplant." 3. "I always had a good appetite. Even with chemo I shouldn't have to make any changes to my diet." 4. "I should be able to finally start a family after I'm finished with the chemo."

1

According to the tumor-node-metastasis (TNM) classification system, T0 means there is which of the following? 1. No evidence of primary tumor 2. Distant metastasis 3. No distant metastasis 4. No regional lymph node metastasis

1

A client has been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions: (Select all that apply.) 1. Assess level of consciousness. 2. Apply pressure to the bleeding sites. 3. Check intake and output records. 4. Assist the client to a chair. 5. Monitor vital signs once a shift.

1, 2, 3

Palliation refers to 1. the spread of cancer cells from the primary tumor to distant sites. 2. relief of symptoms associated with cancer. 3. the lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow. 4. hair loss related to the treatment of cancer.

2

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority? 1. Risk for infection 2. Anxiety 3. Imbalanced nutrition: Less than body requirements 4. Risk for injury

1

The nurse evaluates teaching as effective when a female client states that she will 1. Use sunscreen when outdoors. 2. Obtain a cancer history from her parents. 3. Decrease tobacco smoking from one pack/day to half a pack/day. 4. Exercise 30 minutes 3 times each week.

1

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? 1. It targets normal body cells as well as cancer cells. 2. It causes a systemic reaction. 3. It attacks cancer cells during their vulnerable phase. 4. It functions against disseminated disease.

1

When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor? 1. Radiation can result in myelosuppression. 2. The cancer cells are dying in large numbers. 3. The cancer is spreading. 4. Fighting off infection is an exhausting venture.

1

The nurse is evaluating the client's risk for cancer and recommends changes when the client states she 1. drinks 1 glass of wine at dinner each night 2. uses the treadmill for 30 minutes on 5 days each week 3.works as a secretary at a medical radiation treatment center 4. eats red meat such as steaks or hamburgers every day

4

The physician is attending to a 72-year-old patient with a malignant brain tumor. The physician recommends immediate radiation therapy. Which of the following is a reason for the physician's recommendation? 1. To destroy marginal tissues 2. To remove the tumor from the brain 3. To analyze involved lymph nodes 4. To prevent the formation of new cancer cells

4

Which statement by a client undergoing external radiation therapy indicates the need for further teaching? 1. "I'll not use my heating pad during my treatment." 2. "I'm worried I'll expose my family members to radiation." 3. "I'll wash my skin with mild soap and water only." 4. "I'll wear protective clothing when outside."

2

Which statement by a client undergoing external radiation therapy indicates the need for further teaching? 1. "I'll wash my skin with mild soap and water only." 2. "I'm worried I'll expose my family members to radiation." 3. "I'll not use my heating pad during my treatment." 4. "I'll wear protective clothing when outside."

2

Which type of vaccine uses the patient's own cancer cells, which are prepared for injection, back into the patient? 1. Allogeneic 2. Autologous 3. Therapeutic 4. Prophylactic

2

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? 1. Ate 75% of all meals during the day 2. White blood cell (WBC) count of 9,000 cells/mm3 3. Temperature of 98.3° F (36.8° C) 4. Stage 3 pressure ulcer on the left heel

4

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? 1. Disconnect I.V. tubing with gloved hands. 2. Throw I.V. tubing in the trash after the infusion is stopped. 3. Break needles after the infusion is discontinued. 4. Wear disposable gloves and protective clothing.

4

A patient with brain tumor is undergoing radiation and chemotherapy for treatment of cancer. Of late, the patient is complaining of swelling in the gums, tongue, and lips. Which of the following is the most likely cause of these symptoms? 1. Nadir 2. Extravasation 3. Neutropenia 4. Stomatitis

4

When a patient takes vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the patient needs to be informed that he should report which of the following symptoms that would be an expected side-effect of motor neuropathy? Select all that apply. 1. Loss of balance and coordination 2. Cramps and spasms in the legs 3. Muscle weakness 4. Burning and tingling sensations in the extremities

1, 2, 3

A 5-year-old client has just received stem cell transplantation as treatment for his leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation? 1. Closely monitor the client for at least 3 days. 2. Closely monitor the client for at least 3 months. 3. Closely monitor the client for at least 5 months. 4. Closely monitor the client for at least 4 weeks.

2

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? 1. Blood pressure of 120/64 to 130/72 mm Hg 2. Serum potassium level of 2.6 mEq/L 3. Urine output of 400 ml in 8 hours 4. Sodium level of 142 mEq/L

2

A decrease in circulating white blood cells is 1. thrombocytopenia. 2. leukopenia. 3. neutropenia. 4. granulocytopenia.

2

During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis? 1. Recommending that the client discontinue chemotherapy 2. Providing a solution of viscous lidocaine for use as a mouth rinse 3. Checking regularly for signs and symptoms of stomatitis 4. Monitoring the client's platelet and leukocyte counts

2

The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? 1. "Hair loss may not occur until after the second round of therapy." 2. "I can continue taking my vitamins and herbs because they make me feel better." 3. "I will eat clear liquids for the next 24 hours." 4. "I will use birth control measures until after all treatment is completed."

2

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? 1. "Benign tumors can spread from one place to another." 2. "Benign tumors don't usually cause death." 3. "Benign tumors grow very rapidly." 4. "Benign tumors invade surrounding tissue."

2

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? 1. Monitor the client's toilet patterns. 2. Monitor the client closely to prevent infection. 3. Monitor the client's heart rate. 4. Monitor the client's physical condition.

2

What should the nurse tell a female client who is about to begin chemotherapy and anxious about losing her hair? 1. Her hair will grow back within 2 months post therapy. 2. She should consider getting a wig or cap before she loses her hair. 3. Alopecia related to chemotherapy is relatively uncommon. 4. Her hair will grow back the same as it was before treatment.

2

Which of the following is a characteristic of a malignant tumor? 1. It is usually slow growing. 2. It gains access to the blood and lymphatic channels. 3. It grows by expansion. 4. It demonstrates cells that are well differentiated.

2

Which of the following occurs when there is accumulation of fluid in the pericardial space that compresses the heart? 1. DIC 2. Cardiac tamponade 3. SIADH 4. Superior Vena Cava Syndrome (SVCS)

2

Which of the following would be inconsistent as a common side effect of chemotherapy? 1. Alopecia 2. Weight gain 3. Fatigue 4. Myelosuppression

2

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? 1. Check the client's history for a congenital link to thrombocytopenia. 2. Perform a cardiovascular assessment every 4 hours. 3. Closely observe the client's skin for petechiae and bruising. 4. Monitor daily platelet counts.

3

A month following biopsy, a 75-year-old female client returns to the surgeon's office for a report on her diagnostic procedure to determine the cell composition of her abdominal neoplasm. Which of the following terms is significant to indicate the likelihood of the tumor spreading? 1. Neoplasm 2. Lesion 3. Benign 4. Primary site

3

A newly diagnosed cancer client is crying and states the following to the nurse: "I promised God that I will be a better person if I can just get better." What is the appropriate assessment of this comment by the nurse? 1. Anger directed toward nursing staff is not unusual in dealing with cancer clients. 2. The client is just trying to protect self from potential loss. 3. The cancer is viewed as a punishment from past actions. 4. Loss is inevitable so client is making final plans.

3

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? 1. The client begins to shiver. 2. The client states he is nauseous. 3. The I.V. site is red and swollen. 4. The laboratory reports a white blood cell (WBC) count of 1,000/mm3.

3

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? 1. Erythema 2. Flare 3. Extravasation 4. Thrombosis

3

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? 1. "I take a stool softener every morning." 2. "I use an electric razor to shave." 3. "I floss my teeth every morning." 4. "I removed all the throw rugs from the house."

3

A patient is scheduled for cryosurgery for cervical cancer and tells the nurse, "I am not exactly sure what the doctor is going to do." What is the best response by the nurse? 1. "The physician is going to use medication to inject the area." 2. "The physician is going to use radiofrequency to ablate the area." 3. "The physician is going to use liquid nitrogen to freeze the area." 4. "The physician is going to use a laser to remove the area."

3

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should: 1. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. 2. Modify the diet to acidify the urine, thus preventing uric acid crystallization. 3. Encourage fluid intake, if possible, to dilute the urine. 4. Limit fluids to 1,000 mL/day to minimize stress on the renal tubules.

3

According to the TNM classification system, T0 means there is 1. distant metastasis. 2. no regional lymph node metastasis. 3. no evidence of primary tumor. 4. no distant metastasis.

3

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority? 1. Risk for injury 2. Imbalanced nutrition: Less than body requirements 3. Risk for infection 4. Anxiety

3

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? 1. Withholding fluids for the first 4 to 6 hours after chemotherapy administration 2. Serving small portions of bland food 3. Administering metoclopramide and dexamethasone as ordered 4. Encouraging rhythmic breathing exercises

3

An important nursing function is monitoring factors that may indicate that bleeding is occurring. One serum indicator is a (an): 1. Lymphocyte count of 30%. 2. Reticulocyte count of 1%. 3. Platelet count of 60,000/mm3. 4. Neutrophil count of 60%.

3

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? 1. Initiation 2. Promotion 3. Progression 4. Prolongation

3

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? 1. Palliative 2. Diagnostic 3. Prophylactic 4. Reconstructive

3

The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? 1. "Clients with alopecia will have delay in grey hair." 2. "New hair growth will return without any change to color or texture." 3. "The hair loss is temporary." 4. "Wigs can be used after the chemotherapy is completed."

3

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? 1. Monitor the client's heart rate. 2. Monitor the client's physical condition. 3. Monitor the client closely to prevent infection. 4. Monitor the client's toilet patterns.

3

Which oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)? 1. Cardiac tamponade 2. Disseminated intravascular coagulation (DIC) 3. Syndrome of inappropriate antidiuretic hormone release (SIADH) 4. Tumor lysis syndrome

3

While doing a health history, a client tells you that her mother, grandmother, and sister died of cancer. The client wants to know what she can do to keep from getting cancer. What would be your best response? 1. "With your family history, there is nothing you can do to prevent getting cancer." 2. "If you eat right, exercise, and get enough rest, you can prevent breast cancer." 3. "You can't prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is." 4. "Cancer often skips a generation, so don't worry about it."

3

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? 1. Administering aspirin if the temperature exceeds 102° F (38.8° C) 2. Placing the client in strict isolation 3. Providing for frequent rest periods 4. Inspecting the skin for petechiae once every shift

4

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? 1. Providing for frequent rest periods 2. Administering aspirin if the temperature exceeds 102° F (38.8° C) 3. Placing the client in strict isolation 4. Inspecting the skin for petechiae once every shift

4