PrepU Oncologic Management

A decrease in circulating white blood cells (WBCs) is referred to as a. Granulocytopenia b. Thrombocytopenia c. Leukopenia d. Neutropenia

c; 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 receiving chemotherapy has a nursing diagnosis of deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit? a. "I'II play card games with my friends." b. "I'll take a long trip to visit my aunt." c. "I'll bowl with my team after discharge." d. " I'll eat lunch in a restaurant every day."

a; During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions.

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 a. "You will need to practice birth control measures." b. "You will continue having your menses every month." c. "You will experience menopause now." d. "You will be unable to have children."

a; 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.

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? a. Normal finding b. Benign fibrocystic disease c. Malignant tumor d. Malignant tumor with metastasis to surrounding tissue

c; A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.

A nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of flouridine. What is the time frame the nurse should include with client teaching? a. 24 hours b. 2 to 4 days c. 7 to 14 days d. 21 to 28 days

c; Bone marrow suppression becomes noticeable 7 to 14 days after flouridine administration. Bone marrow recovery occurs in 21 to 28 days.

The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective? a. " I will brush my teeth after every meal." b. "I will reduce smoking to after meals only." c. "I will eat spicy foods with a cool beverage." d. " I will limit alcoholic beverages to one a day."

a; Stomatitis is an inflammatory process of the mouth, including the mucosa and tissues surrounding the teeth. Manifestations of stomatitis include changes in sensation, erythema, and edema, or if severe, painful ulcerations, bleeding, and infection. It commonly develops within 3 to 14 days after receiving certain chemotherapeutic agents. Actions to prevent the development of stomatitis include brushing the teeth with a soft toothbrush for 90 seconds after every meal. Smoking dries oral tissues and should be avoided. Spicy foods can irritate the oral tissues and should be avoided. Alcohol is drying to the oral tissues and should be avoided.

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful? a. "I clean my teeth gently several times per day." b. "I replace my toothbrush every month." c. "I lubricate my lips with petroleum jelly." d. "I use an alcohol-based mouthwash every morning."

a; The client demonstrates understanding when he states that he'll clean his teeth gently several times per day. Frequent gentle cleaning of the mouth or rinsing reduces bacteria build-up in the oral cavity, thus reducing the risk for oropharyngeal infection. Changing the toothbrush each month reduces the bacteria in the mouth for the first few uses only. Petroleum jelly moistens the lips, but doesn't prevent breakdown of the mucous membranes or reduce the risk for oropharyngeal infection. Alcohol-based products cause drying of the mucous membrane, increasing the likelihood of oropharyngeal infection.

An oncology client has just returned from the postanesthesia care unit after an open hemicolectomy. This client's plan of nursing care should prioritize which of the following? a. Assess the client hourly for signs of compartment syndrome. b. Assess the client's fine motor skills once per shift. c. Assess the client's wound for dehiscence every 4 hours. d. Maintain the client's head of bed at 45 degrees or more at all times.

c; Postoperatively, the nurse assesses the client's responses to the surgery and monitors the client for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. Fine motor skills are unlikely to be affected by surgery and compartment syndrome is a complication of fracture casting, not abdominal surgery. There is no need to maintain a high head of bed.

Which is a growth-based classification of tumors? a. Sarcoma b. Carcinoma c. Malignancy d. Leukemia

c; 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.

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: a. The three drugs can be given at lower doses. b. The second and third drugs increase the effectiveness of the first drug. c. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. d. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms

d; 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 is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed? a. "I guess the doctor could not remove the entire tumor." b. "I am so glad the doctor was able to remove the entire tumor." c. "I will be glad to finally be done with treatments for this thing." d. "Thank goodness the tumor is contained and curable."

a; Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.

The nurse is caring for an adult client who has developed a mild oral yeast infection following chemotherapy. What actions should the nurse encourage the client to perform? Select all that apply. a. Use a lip lubricant. b. Scrub the tongue with a firm-bristled toothbrush. c. Use dental floss every 24 hours. d. Rinse the mouth with normal saline. e. Eat spicy food to aid in eradicating the yeast.

a, c, d

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? a. Antimetabolite b. Alkylating c. Nitrosoureas d. Mitotic spindle poisons

a; 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR).

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

b; Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? a. Ability to invade other tissues b. Slow rate of growth c. Causes generalized symptoms d. Undifferentiated cells

b; 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.

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

c; 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.

The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply. a. Egg white omelet with spinach and mushrooms b. Crispy chicken Caesar Salad c. Steamed broccoli and carrots d. Turkey breast on whole wheat bread e. Smoked salmon f. Vegetable and cheddar quiche

a, c, d; Foods high in fat and those that are smoked or preserved with salt or nitrates are associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy low fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad can be a healthy selection but Caesar salads contain much fat from the dressing and addition of cheeses and fried chicken. Salmon that is not smoked would be a good selection. Quiche usually contains high-fat milk, crème, eggs, and cheese.

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? a. "I floss my teeth every morning." b. "I use an electric razor to shave c. "I take a stool softener every morning. d. " I removed all the throw rugs from the house."

a; A client with a platelet count of 30,000/mm? is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the Gl tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.

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

a; A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, IV tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.

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

a; A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm, and shivering require interventions, these findings aren't a high priority at this time.

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? a. "The hair loss is usually temporary." b. "New hair growth will return without any change to color or texture." c. "Clients with alopecia will have delay in grey hair." d. "Wigs can be used after the chemotherapy is completed."

a; Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan.

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? a. "I hope they find a bone marrow donor who matches." b. "The doctor will remove cells from my bone marrow before beginning chemotherapy." c. "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." d. "I will need to attend follow-up visits for up to 3 months after treatment."

a; 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.

To combat the most common adverse effects of chemotherapy, a nurse should administer an: a. antiemetic. b. antimetabolite. c. antibiotic. d. anticoagulant.

a; Antiemetics, antihistamines, and certain steroids treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

Which oncologic emergency involves the accumulation of fluid in the pericardial space? a. Cardiac tamponade b. Disseminated intravascular coagulation (DIC) c. Syndrome of inappropriate antidiuretic hormone release (SIADH) d. Tumor lysis syndrome

a; Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis that results in thrombosis and bleeding. SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician orders mitomycin and other chemotherapeutic agents for palliative treatment. How does mitomycin exert its cytotoxic effects? a. It inhibits deoxyribonucleic acid (DNA) synthesis. b. It inhibits ribonucleic acid (RNA) synthesis. c. It's cell cycle-phase specific. d. It inhibits protein synthesis.

a; Mitomycin (Mutamycin) exerts its cytotoxic effects by inhibiting DNA synthesis rather than RNA synthesis. It's cell cycle-phase nonspecific and doesn't inhibit protein synthesis.

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? a. Extravasation b. Stomatitis c. Nausea and vomiting d. Bone pain

a; 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 serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with: a. anorexia. b. seizure. c. weight gain. d. myalgia.

b; A serum sodium concentration lower than 115 mEq/L (115 mol/L) is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium concentrations lower than 120 mEg/L.

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching? a. cryosurgery b. prophylactic c. local excision d. palliative

b; Also called preventive surgery, prophylactic surgery may be done when there is a family history or genetic predisposition, ability to detect cancer at an early stage, and client acceptance of the postoperative outcome. Local excision is done when an existing tumor is removed along with a small margin of healthy tissue. Palliative surgery relieves symptoms. Cryosurgery uses cold to destroy cancerous cells.

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

b; 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 nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of a. nadir. b. graft-versus-host disease. c. metastasis. d. acute leukopenia.

b; Graft-versus-host disease is a major cause of morbidity and mortality in clients who have had allogeneic transplant. Clinical manifestations of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent diarrhea, abdominal pain, and hepatomegaly.

A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse? a. "It allows time for you to cope with the treatment." b. "It will allow time for the repair of healthy tissue." c. "It will decrease the incidence of leukopenia and thrombocytopenia." d. "It is not really understood why you have to go for 6 weeks of treatment."

b; In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death.

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? a. To remove the tumor from the brain. b. To prevent the formation of new cancer cells. c. To analyze the lymph nodes involved. d. To destroy marginal tissues.

b; 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.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3, N1, MO. What treatment mode should the nurse anticipate? a. No further treatment is indicated. b. Adjuvant therapy is likely. c. Palliative care is likely. d. Repeat biopsy is needed before treatment begins.

b; T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.

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: a. expected chemotherapy-related adverse effects. b. chemotherapy exposure and risk factors. c. signs and symptoms of infection. d. reinforcement of the client's medication regimen.

b; 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 assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis? a. Recommend that the client discontinue chemotherapy. b. Provide a solution of viscous lidocaine for use as a mouth rinse. c. Monitor the client's platelet and leukocyte counts. d. Check regularly for signs and symptoms of stomatitis.

b; 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 caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? a. Monitor the client's toilet patterns. b. Monitor the client to prevent sepsis. c. Monitor the client's physical condition. d. Monitor the client's heart rate.

b; 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.

A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend? a. Low-fat hot dogs b. Smoked ham c. Oranges d. Medium-rare steak

c; A diet high in vitamin C and citrus may help reduce the risk of certain cancers, such as stomach and esophageal cancers. Hot dogs and smoked and cured foods are high in nitrates, which may be linked to esophageal and gastric cancers. Steak is a high-fat food that may increase the risk of breast, colon, and prostate cancers.

Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? a Family history b. Drug history c. Blood studies d. Allergy history

c; Before the HSCT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before an HSCT procedure, the nurse need not evaluate client's family, drug, or allergy history.

A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to: a. Report the unusual sign of nausea. b. Be alarmed if she notices fluid retention. c. Increase her intake of calcium-rich foods. d. Report the unexpected sign of increased appetite and weight gain.

c; One of the major side effects of Aromasin is hypocalcemia and the subsequent loss of bone. Therefore, the patient needs to have periodic blood work done, have bone density tests done, and follow a diet that will supply needed calcium that is being pulled from the bone tissue.

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; 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.

An oncology nurse is caring for a client who relates that certain tastes have changed. The client states that "meat tastes bad." What nursing intervention can be used to increase protein intake for a client with taste changes? a. Stay away from protein beverages. b. Encourage maximum fluid intake. c. Encourage eating cheese, eggs, and legumes. d. Suck on hard candy during treatment.

c; The nurse encourages the clients with taste changes to eat cheese, eggs, and legumes. Encouraging the client to take in the maximum amount of fluids does not increase protein intake. The nurse advises the client to drink protein beverages. Sucking on hard candies during treatment does not increase protein intake.

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? a. It is used to remove cancerous cells using a needle. b. It removes an entire lesion and the surrounding tissue. c. It removes a wedge of tissue for diagnosis. d. It treats cancer with lymph node involvement.

c; 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.

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

c; 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.

A nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal Pap test results for the past 10 years. The client asks about continuing the Pap test. What is the best response by the nurse? a. "You will need to continue for the rest of your life." b. "You need to continue obtaining a Pap test for only the next 5 years." c. "You could have stopped immediately after your hysterectomy." d. "You may choose to discontinue this test."

d; The American Cancer Society recommendations for women 66+ years or older who have had normal Pap tests for 10 years and who have had a total hysterectomy may choose to stop having Pap tests for cervical cancer screening.

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; 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.

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? a. Perform a cardiovascular assessment every 4 hours. b. Check the client's history for a congenital link to thrombocytopenia. c. Monitor daily platelets. d. Closely observe the client's skin for petechiae and bruising.

d; The nurse should closely observe the client's skin for petechia and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.