Saunders Oncology Part 2

In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment.

A client receiving radiation to the larynx is most likely to experience a *sore throat*. Dyspnea may occur with lung involvement. Diarrhea and constipation may occur with radiation to the gastrointestinal tract.

The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse include in discharge instructions?

Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks.

The greatest risk factor for bladder cancer is tobacco use. Exposure to toxins in hair dyes, rubber, paint, electric cable, and textile industries increases risk for bladder cancer.

Chemicals may enter the body through contact with skin and mucous membranes in the respiratory tract. In addition, bladder infections and long-term use of cyclophosphamides may cause bladder cancer.

The nurse is admitting a client with *laryngeal cancer* to the nursing unit. What should the nurse assess for as the most common risk factor for this type of cancer?

Cigarette smoking

Fecal occult blood testing for colorectal cancer should be done annually for both men and women. Less invasive diagnostic testing such as a fecal occult blood test will be performed first.

Colonoscopy is done at age 50 and then every 10 years.

The nurse is counseling a woman about *decreasing her risk for cervical cancer*. Which statement by the client indicates a need for further counseling?

Condoms are needed only if I do not trust a new partner." Condoms should be used for adequate protection, especially with new partners. Sexually transmitted infections (which could be acquired without condom use) increase the client's risk of cervical cancer. Uncircumcised partners may present an increased risk. The woman should adhere to guidelines for early detection of cervical cancer (by Pap test) and should seek prompt treatment of vaginitis and cervicitis if they occur.

A client with bladder cancer has undergone surgical removal of the bladder with creation of an ileal conduit. Which assessment findings indicate that the client is developing complications? Select all that apply.

Dusky appearance of the stoma Stoma protrusion from the skin Sharp abdominal pain with rigidity

*Vena cava syndrome* occurs when the superior vena cava is compressed or obstructed by tumor growth.

Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms . Mental status changes and cyanosis are late signs.

Charc of left colon tumors

Frequent diarrhea Crampy gas pains Flat, ribbon-like stools

Chemotherapy may cause distortion of taste.

Frequently, beef and pork are reported to taste bitter or rancid. The nurse can promote client nutrition by helping the client choose alternative sources of protein in the diet, such as mild-tasting fish, cold chicken, turkey, eggs, or cheese.

The most common risk factor associated with laryngeal cancer is cigarette smoking.

Heavy alcohol use and the combined use of alcohol and tobacco increase the risk. Another risk factor is exposure to environmental pollutants.

Epithelial cells of the head and neck are destroyed by radiation. Examining the oral mucosa is a preventive intervention so that changes in the mucosa will be noted immediately.

Inflammation and ulceration also occur because of rapid cell destruction, thereby impairing normal saliva excretion and distribution. Artificial saliva aids in preventing further damage by lubricating the affected area. The client with dysphagia has difficulty swallowing, not difficulty speaking; therefore, teaching him to speak slowly and enunciate clearly will provide no health benefit for his impairment in swallowing. A client with difficulty swallowing should avoid drinking thin liquids because of the increased risk of aspiration owing to epiglottis dysfunction related to radiation therapy.

The nurse is monitoring a client with chronic lymphocytic leukemia (CLL). Which sign should the nurse specifically monitor for and report to the health care provider?

Lymphadenopathy CLL causes a slow increase in immature B cells. These cells infiltrate the bone marrow, lymph nodes, spleen, and liver. CLL eventually causes bone marrow failure; therefore, the client will have enlarged and swollen lymph nodes.

A high daily fluid intake should be maintained to limit clot formation and prevent infection during cancer tp of the prostate.

Small pieces of tissue or blood clots may be passed during urination for up to 2 weeks after surgery; this is an expected occurrence.

The community nurse is conducting a health promotion program, and the topic of the discussion relates to the risk factors for gastric cancer.

Smoking Foods containing nitrates A diet of smoked, highly salted, and spiced foods

Cancer is a neoplastic disorder that can involve all body systems. In cancer, cells lose their normal growth-controlling mechanism.

Some signs and symptoms include sores that do not heal, a nagging cough or hoarseness, indigestion or difficulty swallowing, and a change in bowel or bladder habits. Areas of alopecia occur following cancer chemotherapy. Absence of menses is not a specific sign; however, abnormal occurrence of menses may be.

After a warm bath or shower, the scrotum is relaxed, making it easier to perform.

TSE

67-year-old man is receiving outpatient radiation treatments for carcinoma of the oropharynx and has developed dysphagia. The nurse develops a teaching plan regarding dysphagia and includes which interventions in the plan? Select all that apply.

Teach the man to examine his oral mucosa daily. Encourage the man to use artificial saliva to manage dryness.

The oncology nurse specialist provides an educational session for nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which is a characteristic of the disease?

The disease occurs most often in those older than 75 years of age. Hodgkin's lymphoma is a cancer that can occur at any age but appears to peak in 2 different age groups: in teens and young adults and in adults in their 50s and 60s. The remaining options are characteristics of this disease.

Following abdominal perineal resection, a colostomy should begin to function within 72 hours after surgery, although it may take up to 5 days.

The nurse should monitor for a return of peristalsis by listening for bowel sounds and checking for the passage of flatus. Absent bowel sounds indicate that peristalsis has not returned The client would remain NPO (nothing by mouth) until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from a colostomy.

A high-fiber diet actually lessens the chances of developing colorectal cancer. This type of cancer most often occurs in populations with

diets low in fiber and high in refined carbohydrates, fats, and meats. Other risk factors include a family history of the disease, rectal polyps, and active inflammatory disease of at least 10 years' duration.

older women are less likely to

have mammograms.

The goal of hormones tp in prostate cancer is to

limit the amount of circulating androgens, because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms.

TSE should be performed

once a month Small lumps or abnormalities should be reported.

*Hodgkin's lymphoma* is a cancer that can occur at any age but appears to peak in 2 different age groups:

1- Teens/young adults 2- adults in their 50s and 60s.

A 67-year-old man is receiving outpatient radiation treatments for carcinoma of the oropharynx and has developed dysphagia. The nurse develops a teaching plan regarding dysphagia and includes which interventions in the plan? Select all that apply.

Teach the man to examine his oral mucosa daily. Encourage the man to use artificial saliva to manage dryness.

The client reports to the nurse that while performing testicular self-examination, he found a lump the size and shape of a pea. Which statement is the most appropriate response to the client?

That's important to report even though it might not be serious."

The nurse is taking a history from a client suspected of having testicular cancer. Which data will be most helpful in determining the risk factors for this type of cancer?

Age & Race

The nurse should include which intervention in the care of a client who has undergone a vaginal hysterectomy for the treatment of cancer? Select all that apply.

Encourage ambulation as prescribed. Remove antiembolism stockings twice daily. Assist with range-of-motion (ROM) leg exercises. Check placement of pneumatic compression boots. The client is at risk for deep vein thrombosis (DVT) or thrombophlebitis after this surgery, as with any other major surgery. The nurse should avoid using the knee gatch in the bed because doing so inhibits venous return, thus placing the client at greater risk for DVT or thrombophlebitis. The nurse will implement measures that prevent DVT or thrombophlebitis; ROM exercises, ambulation, antiembolism stockings, and pneumatic compression boots are all helpful.

client with leukemia is receiving busulfan and allopurinol. The nurse should tell the client that the purpose of the allopurinol is to prevent which symptom?

Hyperurcima

The nurse is providing care to a client who has undergone modified right mastectomy for the treatment of breast cancer. Which activity should the nurse incorporate into the plan of care?

Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow. The client should have the head of the bed elevated at least 30 degrees with the affected arm elevated on a pillow. Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. Gentle suction must be maintained on the drain bulb to prevent fluid accumulation at the operative site. With short hospital stays, drainage tubes are usually removed about 1 to 3 weeks after hospital discharge when the client returns for an office visit. All staff must avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood.

The client with a *cervical radiation implant* should be maintained

on *bed rest* in the *dorsal position* to prevent movement of the radiation source. Thead of the bed is elevated to a max of 10 -15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.

Testicular cancer almost always occurs in

only 1 testicle and is usually a pea-size, painless lump when discovered. The cancer is highly curable if found early.

Rather than using the woman's age to decide on screening and treatment measures, the woman's

overall health is used to make these determinations, since health status has a greater influence on tolerance to treatment.

A high-fat diet plays a role in the development of cancer of the

pancreas and other types of cancers.

Hormone therapy (androgen deprivation) is a mode of treatment for

prostatic cancer.

To create an *ileal conduit*, the surgeon takes a

short segment of the small intestine and reconnects the remaining intestine so that it functions normally. One end of the removed segment of intestine is placed at the skin surface to create the stoma. The stoma should be red and moist. A pale, dusky stoma indicates poor vascular supply that could result in necrosis. The stoma should be flush to the skin. The client should not have sharp abdominal pain with rigidity, an indication of peritonitis. Any of these findings should be reported to the health care provider.

Stomatitis is inflammation of the oral cavity, that can happen w/ chemo & radiation. using commercial mouthwashes containing alcohol or encouraging spicy foods will cause pain. Foods are better tolerated by the client with stomatitis when

the food is cool or of neutral temperature. It is important to monitor for oral *fungal infections*, but this assessment should be completed at least *daily*

Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving *chemotherapy*, uric acid levels increase as a result of

the massive cell destruction that occurs because of the chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy.

The client who has undergone a prostatectomy should avoid lifting objects heavier than 20 lb (9 kg) for *at least 6 weeks*. Driving a car and sitting for long periods are restricted for at least

3 weeks.

The nurse is caring for a client who has undergone a *radical neck dissection* and creation of a *tracheostomy* because of *laryngeal cancer* and is providing discharge instructions to the client. Which should be included in the instructions? Select all that apply.

Protect the stoma from water. Use a humidifier if dryness is a problem. Keep powders and sprays away from the stoma site. Apply a thin layer of non-oil-based ointment to the skin around the stoma to prevent cracking. Air conditioners should be avoided to prevent excessive coldness. The remaining options are appropriate interventions regarding stoma care after radical neck dissection and creation of a tracheotomy.

Incidence of bladder cancer

greater in men than in women and affects *white people* twice as often as black people.

Risk factors for *cervical cancer* include

human papillomavirus infection active and passive cigarette smoking certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, and male partners with multiple sex partners). Screening via regular gynecological examinations and Papanicolaou (Pap) tests with treatment of precancerous abnormalities decreases the incidence and mortality of cervical cancer.

Hoarseness is a common early sign of

laryngeal cancer Hoarseness that lasts for 6 weeks is not associated with an acute problem, such as laryngitis.

The nurse has provided instructions to a client receiving external radiation therapy. Which client statement would indicate a need for *further instruction* regarding self-care related to the radiation therapy?

I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding. The client should avoid pressure on the irritated area and should wear loose-fitting clothing. Specific health care provider instructions would be necessary if an alteration in skin integrity occurred as a result of the radiation therapy.

A client calls the ambulatory care clinic and tells the nurse that she found an area that looks like the peel of an orange when performing breast self-examination (BSE) but found no other changes. What is the nurse's best response to this client?

I am glad you called to report this finding. Can you come to the clinic to see your health care provider tomorrow?" Peau d'orange or orange peel appearance of the skin over the breast is associated with late breast cancer. Therefore, the nurse would arrange for the client to come to the clinic as soon as possible. Peau d'orange is not indicative of an infection.

The nurse is reviewing the *preoperative* prescriptions for a client with a *colon tumor* who is scheduled for *abdominal perineal resection* and notes that the health care provider has prescribed *neomycin* for the client. After discussing a prescription for neomycin with the nursing student who is caring for the client, the nurse determines that the student understands the rationale for administration if which statement is made?

It will help decrease activity in the bowel To reduce the risk of contamination at the time of surgery, the surgeon may prescribe that the bowel is emptied and cleansed. Laxatives and enemas may be prescribed to empty the bowel. An intestinal anti-infective such as neomycin may also be prescribed to decrease the bacteria in the bowel. There are no data in the question that indicate that the client has an infection or is allergic to penicillin. The medication does not prevent immune dysfunction.

Which statement made by a client who will undergo cytoreductive (debulking) surgery for ovarian cancer indicates that teaching by the nurse was effective?

The surgery will help to reduce the size of the tumor." Cytoreductive or debulking surgery may be used if a large tumor cannot be removed completely, as is often the case with late-stage ovarian cancer (e.g., the tumor is attached to a vital organ or has spread throughout the abdomen). When this occurs, as much tumor as possible is removed, and adjuvant chemotherapy or radiation may be prescribed. Therefore, the remaining options are incorrect purposes for cytoreductive surgery.

A client receiving chemotherapy is experiencing mucositis. The nurse should advise the client to use which item as the best substance to rinse the mouth?

Weak salt and bicarbonate mouth rinse An *acidic environment* in the mouth is *favorable for bacterial growth*, particularly in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of the presence of severe plaque, it should be a weak solution, because hydrogen peroxide dries the mucous membranes.

*Thrombocytopenia* is a condition in which the platelets fall below the *number needed for normal coagulation*. When a client has thrombocytopenia, the risk of bleeding is greatly increased. To monitor for bleeding, the nurse should

check all secretions for frank or occult blood *Valsalva maneuvers* (as in straining to have a stool, vomiting, or sneezing) could cause intracerebral bleeding when the platelet count is low. To avoid constipation, the nurse would encourage the client to take more fluids and increase his or her dietary fiber. The nurse should encourage the client to use a soft toothbrush or oral sponges to decrease irritation to the mouth and bleeding from the gums. An electric razor is recommended for shaving during times when the client is thrombocytopenic. The nurse should not take rectal temperatures or use any rectal suppositories because of the risk for injury to the rectal membranes with resultant bleeding. Medications should not be given subcutaneously or intramuscularly because use of these routes carries a risk for hemorrhage into the tissues.

A client with a medical diagnosis of breast cancer is undergoing chemotherapy. The client complains to the nurse about losing her hair and severe fatigue from the treatment. Which interventions should the nurse implement for this client? Select all that apply. Review side effects of chemotherapy and treatment with the client. Teach the client how to resolve specific concerns of her personal life. Teach the client to pace activities with rest so as to maintain strength. Offer information on available counseling services and support groups. Tell the client about some other clients who have had breast cancer treatment. Inquire how the cancer diagnosis and treatment affect the client's normal routine.

Review side effects of chemotherapy and treatment with the client. Teach the client to pace activities with rest so as to maintain strength. Offer information on available counseling services and support groups Inquire how the cancer diagnosis and treatment affect the client's normal routine. It Is not therapeutic nor is it the nurse's role to teach the client how to resolve specific concerns of her personal life. The nurse should determine how the cancer diagnosis and treatment are affecting the client's normal routine, and the client should be aware of potential side effects of treatment so as to cope with the events with medications or other measures. It is important for the nurse to inform clients about support groups available (i.e., Reach for Recovery) so the client does not feel isolated. Teaching clients to pace activities even when they feel well will conserve energy so they ultimately feel stronger and less fatigued. It is a breach of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA) laws for the nurse to discuss other clients and their medical proble

The nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. The nurse should teach the client to put the pillow in which location for self-examination of the right breast?

Under the right shoulder The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder, and vice versa. Therefore, options 1, 2, and 4 are incorrect.

With intravesical instillation, normally the medication is injected into the bladder through a

urethral catheter the catheter is clamped or removed, and the client is asked to *retain the fluid for 2 hours*. The client changes position every 15 to 30 minutes, usually from side to side and from supine to prone. The client then voids and is instructed to drink water to flush the bladder.

Characteristic symptoms of right colon tumors include

vague, dull, abdominal pain exacerbated by walking and dark red- or mahogany-colored blood mixed in the stool. The symptoms described in the other options are associated with left colon tumors.

Two basic but important risk factors for testicular cancer are age and race. The disease occurs most frequently in

white males generally between the ages of 15 and 34 years. Other risk factors include a: hx of undescended testis family hx of testicular cancer. In addition, the number of sexual partners is not associated with testicular cancer.

Breast cancer occurs most often in

women who are 65 years of age or older

The nurse is caring for a client undergoing external radiation. The client has developed a dry desquamation of the skin in the treatment area, and the nurse is teaching about management of the skin reaction. Which comment made by the client suggests understanding of the instructions?

When bathing I will use lukewarm water on the affected area." Radiation therapy causes skin cells to break down and die. This can cause a disruption in skin integrity. The client needs to use special and gentle skin care during treatment. This means washing with lukewarm water and not rubbing skin. The client will need to protect the skin from the sun even after radiation therapy is completed. The sun can burn the skin even on cloudy days or when the client is outside even for just a few minutes. The health care provider (HCP) may prescribe a high sun protection factor sunscreen. Care should be taken to not use extreme water temperatures, heating pads, ice packs, or other hot or cold items on the treatment area; these items can disrupt skin integrity. No products (creams, lotions, ointments, perfumes) should be used on the skin during radiation without approval of the HCP.