#1 Chapter 15: Management of Patients with Oncologic Disorders
The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? A) Monthly self-breast exams B) Smoking cessation C) Annual colonoscopies D) Monthly testicular exams
Ans: B Feedback: Cancer is second only to cardiovascular disease as a leading cause of death in the United States. Although the numbers of cancer deaths have decreased slightly, more than 570,000 Americans were expected to die from a malignant process in 2011. The leading causes of cancer death in the United States, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women, so smoking cessation is the health promotion initiative directly related to lung cancer.
The nurse is admitting an oncology patient to the unit prior to surgery. The nurse reads in the electronic health record that the patient has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem? A) Cognitive deficits B) Impaired wound healing C) Cardiac tamponade D) Tumor lysis syndrome
Ans: B Feedback: Combining other treatment methods, such as radiation and chemotherapy, with surgery contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis.
A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting this patients nutritional needs? A) Administration of parenteral feeds via a peripheral IV B) TPN administered via a peripherally inserted central catheter C) Insertion of an NG tube for administration of feeds D) Maintaining NPO status and IV hydration until treatment completion
Ans: B Feedback: If malabsorption is severe, or the cancer involves the upper GI tract, parenteral nutrition may be necessary. TPN is administered by way of a central line, not a peripheral IV. An NG would be contraindicated for this patient. Long-term NPO status would result in malnutrition.
The clinic nurse is caring for a patient whose grandmother and sister have both had breast cancer. She requested a screening test to determine her risk of developing breast cancer and it has come back positive. The patient asks you what she can do to help prevent breast cancer from occurring. What would be your best response? A) Research has shown that eating a healthy diet can provide all the protection you need against breast cancer. B) Research has shown that taking the drug tamoxifen can reduce your chance of breast cancer. C) Research has shown that exercising at least 30 minutes every day can reduce your chance of breast cancer. D) Research has shown that there is little you can do to reduce your risk of breast cancer if you have a genetic predisposition.
Ans: B Feedback: Large-scale breast cancer prevention studies supported by the National Cancer Institute (NCI) indicated that chemoprevention with the medication tamoxifen can reduce the incidence of breast cancer by 50% in women at high risk for breast cancer. A healthy diet and regular exercise are important, but not wholly sufficient preventive measures.
A patients most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patients cancer cells spread? A) Hematologic spread B) Lymphatic circulation C) Invasion D) Angiogenesis
Ans: B Feedback: Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis.
A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? A) Pruritis (itching) B) Nausea and vomiting C) Altered glucose metabolism D) Confusion
Ans: B Feedback: Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these patients. Confusion, alterations in glucose metabolism, and pruritis are not common adverse effects.
A nurse is creating a plan of care for an oncology patient and one of the identified nursing diagnoses is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection-related death in oncology patients? A) Encourage several small meals daily. B) Provide skin care to maintain skin integrity. C) Assist the patient with hygiene, as needed. D) Assess the integrity of the patients oral mucosa regularly.
Ans: B Feedback: Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Malnutrition in oncology patients may be present, but it is not the leading cause of infection-related death. Poor hygiene does not normally cause events that result in death. Broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.
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?
"I floss my teeth every morning"
A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching?
"I'll use hats to protect my head from the sun when my hair falls out"
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?
"It will decrease the incidence of leukopenia and thrombocytopenia"
Patients undergoing radiation therapy to the head and neck may experience ____________ which is a severe impairment of taste.
"mouth blindness,"
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?
"the hair loss is usually temporary"
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?
"the physician is going to use liquid nitrogen to freeze the area."
In response to recognizing TAAs as foreign, T-cell lymphocytes release several cytokines that elicit various immune system actions, including:
(1) proliferation of cytotoxic (cell-killing) T lymphocytes capable of direct destruction of cancer cells (2) induction of cancer cell apoptosis (3) recruitment of additional immune system cells that contribute to the destruction and degradation of cancer cells.
signs and symptoms of HSOS may include:
(hepatic sinusoidal obstructive syndrome) - weight gain, hepatomegaly, increased bilirubin, and ascites.
Patients with CACS complain of loss of appetite, early satiety, and fatigue. As many as _____% of all patients with cancer experience some degree of cachexia
*Cancer-Related Anorexia-Cachexia Syndrome - 80
As the ANC declines below ________ cells/mm3, the risk of infection rises.An ANC less than ________cells/mm3 reflects a severe risk of infection
*absolute neutrophil count (ANC) 1,500 500
Neutropenia, an abnormally low ANC, is associated with an increased risk of infection.
*absolute neutrophil count (ANC) true
radiation safety precautions (brachytherapy) include limiting time with client, wearing dose meter badges, keeping pregnant staff or visitors and children out of room, limiting visits to ____ minutes and keeping ___ feet away from the radiation source
- 30 - 6 feet
what type of diet is suggested to patients that had a Hematopoietic Stem Cell Transplantation
- A neutropenic diet is usually prescribed for patients to decrease the risk of exposure to foodborne infections from bacteria, yeast, molds, viruses, and parasites
Assessment of Neutropenic Fever in Patients With Cancer
- Any one-time temperature of 38.3°C (101°F) or - Any temperature of ≥38°C (100.4°F) or ≥1 h - <500 neutrophils/mcL or <1000 neutrophils/mcL and predicted to decline to ≤500 neutrophils/mcL over the next 48 hour
What should the nurse advise the client to do to help with stomatitis?
- Avoid mouthwashes containing alcohol - avoid tobacco - Use of soft toothbrush - Avoid rough, hot or spicy foods - Removal of dentures unless they're eating
In erythematous areas:
- Avoid t soaps, cosmetics, perfumes, powders, lotions, and ointments -Use only lukewarm water to bathe the area. - Avoid rubbing or scratching the area. -Avoid shaving the area with a straight-edged razor. - Avoid applying hot-water bottles, heating pads, ice, and adhesive tape to the area. - Avoid exposing the area to sunlight or cold weather. - Avoid tight clothing in the area. Use cotton clothing. - aloe vera, or Biafine
Hormonal Agents
- Bind to hormone receptor sites that alter cellular growth - block binding of estrogens to receptor sites (antiestrogens) - inhibit RNA synthesis - suppress cytochrome P450 system
How does graft vs host disease present?
- Blistering rash - Diffuse inflammation to the GI tract with massive diarrhea - Hepatomegaly
Arsenic trioxide (Trisenox)
- Causes fragmentation of DNA resulting in cell death - in acute promyelocytic leukemia, it corrects protein changes and changes malignant cells into normal white blood cells.
nitrosoureas side effects
- Delayed and cumulative myelosuppressio, especially thrombocytopenia - nausea, vomiting, pulmonary, hepatic and renal damage
If wet desquamation occurs:
- Do not disrupt any blisters that have formed. - Avoid frequent washing of the area. -Report blistering. - Use prescribed creams or ointments - topical antibacterial creams may help to dry a wet wound (e.g., Silvadene cream) - If area weeps, apply a nonadhesive absorbent dressing. - If the area is without drainage, moisture and vapor-permeable dressings, such as hydrocolloids and hydrogels on noninfected areas, have been used in many settings.
Antitumor Antibiotics
- Interfere with DNA synthesis by binding DNA - prevent RNA synthesis
Antimetabolites
- Interferes with the biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis; inhibits DNA replication and repair *Cell cycle—specific (S phase)
•M- The absence of presence of distant metastasis
- Mx Distant metastasis cannot be assessed - M0 No distant metastasis - M1 Distant metastasis
N- The absence or presence and extent of regional lymph node metastasis
- Nx Regional lymph nodes cannot be assessed - N0 No regional Lymph nodes metastasis - N1,2,3 Increasing involvement of regional lymph nodes
Superior Vena Cava Syndrome (SVCS) clinical manifestations
- Progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling - Edema of the neck, arms, hands, and thorax and reported sensation of skin tightness, difficulty swallowing, and stridor - engorged and distended jugular, temporal, and arm veins - Dilated thoracic vessels causing prominent venous patterns on the chest wall - Increased intracranial pressure
- A person diagnosed with breast cancer has a TNM staging of T2N1M0. What does that mean?
- The person has a larger than normal or extent of a primary tumor 2 out of 4 - one lymph node involved - no distant metastasis.
T- The extent of the primary tumor
- Tx Primary tumor cannot be assessed - T0 No evidence of primary tumor - Tis Carcinoma in situ - T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor
Prevent or minimize hair loss through the following:
- Use scalp hypothermia and scalp tourniquets -Cut long hair before treatment. - gently pat dry, and avoid excessive shampooing. - Avoid curling irons, dryers, clips, barrettes, hair sprays, hair dyes, and permanent waves. - Avoid excessive combing or brushing; use wide-toothed comb.
Cancer-Related Anorexia-Cachexia Syndrome
- a complex biologic process that results from a combination of increased energy expenditure and decreased intake - The patient experiences continued weight loss and malnutrition characterized by loss of adipose tissue, visceral protein, and skeletal muscle mass
Indications of extravasation during administration include:
- absence of blood returned from the IV catheter - resistance to flow of IV fluid - burning or pain, swelling, or redness at the site
graft-versus-host disease (GVHD)
- an immune response initiated by T lymphocytes of donor tissue against the recipient's tissues (skin, gastrointestinal tract, liver) * an undesirable response
Bone marrow cells proliferate rapidly, and if sites containing bone marrow (e.g., the iliac crest or sternum) are included in the radiation field, ___________, _________ (decreased white blood cells [WBCs]), and ____________ (a decrease in platelets) may result.
- anemia - leukopenia (decreased white blood cells [WBCs]) -thrombocytopenia (a decrease in platelets)
how would you manage nausea and vomiting in a patient?
- antiemetics (give before chemo starts) -serotonin receptor antagonist (e.g., ondansetron) and a corticosteroid (e.g., dexamethasone), given orally or intravenously. - benzodiazepine (e.g., lorazepam) - limit oral intake for a few hours
How are TSA's used clinically?
- assess the extent of the disease - track the course of illness during chemotherapy and relapse
What will the nurse monitor for postoperatively after a tumor removal?
- bleeding, - infection, - wound dehiscence, - fluid and electrolyte imbalances, - pain management.
Stomatitis is characterized by:
- changes in sensation -mild redness (erythema), and edema or, if severe, by painful ulcerations, bleeding, and secondary infection.
Cancers with these underlying genetic abnormalities include:
- chronic myelogenous leukemia -meningiomas - acute leukemia - retinoblastomas -Wilms tumor
Factors that contribute to the severity of radiation dermatitis include:
- dose and form of radiation - inclusion of skin folds in the irradiated area - increased age - the presence of medical comorbidities
Two types of ionizing radiation
- electromagnetic radiation (x-rays and gamma rays) - particulate radiation (electrons, beta particles, protons, neutrons, and alpha particles)
Some medications may cause bone marrow toxicity leading to decreases in circulating platelets.
- heparin - vancomycin
examples of viruses that cause cancer?
- human papillomavirus (HPV) - hepatitis B virus (HBV) - Epstein-Barr virus (EBV) (Burkitt lymphoma and nasopharyngeal cancer)
Vesicants are those agents that, if deposited into the subcutaneous or surrounding tissues (extravasation), cause:
- inflammation - tissue damage - possibly necrosis of tendons, muscles, nerves, and blood vessels.
Carcinogenesis is thought to be a three-step cellular process:
- initiation, - promotion, - progression
Nurses need to reduce the risk for infection. How? by implementing
- neutropenic precautions - avoiding rectal or vaginal procedures - using electric razors - avoid using stagnant water - reduce exposure to sources of infection
For any frequent or prolonged administration of antineoplastic vesicants, ________________, _____________________, or __________________ should be inserted to promote safety during medication administration and reduce problems with access to the circulatory system
- right atrial silastic catheters - implanted venous access devices - peripherally inserted central catheters (PICCs)
Pap test
- start at 21 -Screening should be done every 3 years
chronic side effects Hematopoietic Stem Cell Transplantation
- sterility - pulmonary, cardiac, renal, neurologic, and hepatic dysfunction - osteoporosis - avascular bone necrosis - diabetes - secondary malignancy
Alterations in oral mucosa secondary to radiation therapy in the head and neck region include:
- stomatitis -decreased salivation and xerostomia -change in or loss of taste -mucositis
Some chemotherapy agents damage the kidneys because they impair water secretion, leading to:
- syndrome of inappropriate secretion of antidiuretic hormone (SIADH) - decrease renal perfusion - precipitate end products after cell lysis - cause interstitial nephritis
implanted vascular access device
- used for administration of medications, fluids, blood products, and nutrition. - The self-sealing septum permits repeated puncture by Huber needles without damage or leakage. *for long term use of vesicants
hypersensitivity reactions (HSRs) are a subgroup of adverse drug reactions that are unexpected and associated with mild or progressively worsening signs and symptoms, such as rash, urticaria, fever, hypotension, cardiac instability, dyspnea, wheezing, throat tightness, and syncope. Immediate HSRs appear within ___ hour of an infusion, while delayed HSRs may occur hours afterward.
-1
Early onset of menses before age ___ and delayed onset of menopause after age ____, null parity (never giving birth), and delayed childbirth after age ____ are all associated with an increased risk of breast cancer.
-12 - 55 -30
Screen for cancer: - annual mammogram starting at age ___, colonoscopy at age ___ every 10 years, annual fecal occult blood test at age ____, PSA at age ____, pap smear every ____ years
-40 -50 -50 -50 - at 21 every 3 years
The use of hyperthermia (thermal therapy), which is the generation of temperatures greater than physiologic fever range (greater than _____°C [____°F]), has been used for many years to destroy cancerous tumors.
-41.5 - 106.7
Acute CINV is experienced in the first 24 hours after chemotherapy with a maximal intensity after ___ -____ hours; delayed CINV occurs 24 hours posttreatment and may last as many as ___ days with a maximal intensity 48-72 hours after drug administration
-5-6 -7
The primary neuroreceptors known to be implicated in CINV are:
-5-hydroxytryptamine (5-HT or serotonin) - dopamine receptor
The risk of bleeding increases when the platelet count decreases below ________________. At platelet counts lower than 10,000/mm3 (0.02 × 1012/L), the risk for spontaneous bleeding is increased
-50,000/mm3 (0.05 × 1012/L)
Endometrial
-At the time of menopause, women at average risk should be informed about risks and symptoms of endometrial cancer and encouraged to report any unexpected bleeding or spotting to their physicians.
Cancer Vaccines
-Cancer vaccines mobilize the body's immune response to prevent or treat cancer. These vaccines contain either portions of cancer cells alone or portions of cells in combination with other substances (adjuvants) that can augment or boost immune responses.
primary radiotherapy modalities
-EBRT - brachytherapy (a form of internal radiation) - systemic (radioisotopes) - contact or surface molds.
Biopsy Types
-Excisional biopsy (for small, easily accessible tumors) - Incisional biopsy (operformed if the tumor mass is too large to be removed) - Needle biopsy (is performed to sample suspicious masses that are easily and safely accessible)
What are the differences between benign and malignant cells?
-Malignant cells invade tissue - Bening are more well differentiate
Prostate
-Men, age 50+ -
Superior Vena Cava Syndrome (SVCS) nursing intervention
-Monitor cardiopulmonary and neurologic status. -Avoid upper extremity venipuncture and blood pressure measurement - instruct patient to avoid tight or restrictive clothing and jewelry on fingers, wrist, and neck. -semi-Fowler position -avoid completely supine or prone position -Promote energy conservation to -administer fluids cautiously to minimize edema. -radiation-related problems such as mucositis with resultant dysphagia (difficulty swallowing) and esophagitis. -Monitor for chemotherapy-related problems, such as myelosuppression.
how to prevent renal toxicity due to chemotherapy?
-Monitoring laboratory values of blood urea nitrogen (BUN), serum creatinine, creatinine clearance, and serum electrolytes - Adequate hydration - diuresis - alkalinization of the urine to prevent formation of uric acid crystals - administration of allopurinol (Zyloprim)
four most common emergencies related to chemotherapy?
-Superior Vena Cava Syndrome (SVCS) -Spinal Cord Compression -Hypercalcemia -Tumor Lysis Syndrome (TLS)
Carcinogenesis: progression
-The mutant, proliferating cells begin to exhibit malignant behavior. These cells begin to accumulate more and more mutations with each division. * angiogenesis occur
Gene Therapy
-Tumor-directed therapy (introduction of a therapeutic gene (suicide gene) into tumor cells in an attempt to destroy them.) -Active immunotherapy (administration of genes that will invoke the antitumor responses of the immune system) -Adoptive immunotherapy (dministration of genetically altered lymphocytes that are programmed to cause tumor destruction.)
Mild stomatitis (generalized erythema, limited ulcerations, small white patches: Candida) nursing intervention
-Use normal saline mouth rinses every 1-4 hours. -Use soft toothbrush or toothette. -Remove dentures except for meals -Apply water-soluble lip lubricant -Avoid foods that are spicy or hard to chew
Vascular imaging
-Use of contrast agents that are injected into veins or arteries and monitored by fluoroscopy, CT, or MRI imaging in order to assess tumor vasculature. - Used to assess tumor vascularity prior to surgical procedures. Use in assessing the efficacy of antiangiogenesis (preventing new blood vessel formation) drugs is largely investigational *Liver and brain cancers
acute fatigue vs cancer-related fatigue
-acute fatigue: occurs after an energy-demanding experience - cancer-related fatigue: a distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning
Hemorrhagic cystitis is a bladder toxicity that can result from cyclophosphamide and ifosfamide therapy. management
-aggressive IV hydration - frequent voiding, and diuresis - Mesna (Mesnex) is a cytoprotectant agent that binds with the toxic metabolites of cyclophosphamide or ifosfamide in the kidneys to prevent hemorrhagic cystitis.
altered skin integrity due to radiation:
-alopecia (hair loss) -erythema and dry desquamation (flaking of skin) -moist or wet desquamation (dermis exposed, skin oozing serous fluid) -ulceration
AlloHSCTs are used primarily for diseases of the__________ and are dependent on the availability of a human leukocyte antigen-matched donor, which greatly limits the number of possible transplants.
-bone marrow *Allogeneic HSCT (AlloHSCT): From a donor
Carcinogenesis: Initiation
-carcinogens cause mutations in the cellular DNA - cells escape apoptosis (programed cell death)
Carcinogenesis: Promotion
-co-carcinogens) causes proliferation and expansion of initiated cells - leads to the formation of a preneoplastic or benign (noncancerous) lesion.
Severe late effects of radiation include:
-fibrosis, atrophy, ulceration, and necrosis * may affect the lungs, heart, central nervous system, and bladder.
peripherally inserted central catheters (PICCs)
-for long term use of vesicants
Measures to avoid bleeding include:
-giving oprelvekin to stimulate platelet production and prevent thrombocytopenia - avoiding trauma, including venipuncture and injections, when possible - using an electric razor for shaving - stop brushing and flossing the teeth.
myelosuppression management
-granulocyte colony-stimulating factor [G-CSF] and granulocyte-macrophage colony-stimulating factor [GM-CSF] -Erythropoietin (EPO) - Interleukin 11 (IL-11)
Myelosuppression due to chemotherapy is predictable. What do we see?
-patients blood counts are lowest 7 to 14 days after chemotherapy has been given -fever associated with neutrophil count less than 1,500 cells/mm3 *Frequent monitoring of blood cell counts is essential
Interleukin 11 (IL-11)
-stimulates the production of megakaryocytes (precursors to platelets) and can be used to prevent and treat severe thrombocytopenia but has had limited use because of toxicities, such as HSR; capillary leak syndrome; pulmonary edema; atrial dysrhythmias; and nausea, vomiting, and diarrhea
Chemotherapy is used primarily to treat _________ disease rather than _________ lesions that are amenable to surgery or radiation.
-systemic -localized
Severe stomatitis (confluent ulcerations with bleeding and white patches covering >25% of oral mucosa) nursing intervention
-tissue samples for culture - ability to chew and swallow,assess gag reflex -place patient on side and irrigate mouth; have suction available. -Remove dentures. - toothette or gauze soaked with solution for cleansing. -water-soluble lip lubricant. -liquid or pureed diet -Monitor for dehydration. -Consult primary provider for use of topical anesthetic, such as dyclonine and diphenhydramine, or viscous lidocaine.
Nursing management during stem cell infusion:
-vital signs and blood oxygen saturation - assessing for adverse effects - providing strategies for symptom control, ongoing support, and patient education.
The onset of gradually progressing alopecia and body hair loss associated with targeted therapies generally occurs ___ to ____ months after the start of treatment and may be patchy appearing as temporal or frontal hair loss.
1 to 3
Stereotactic body radiotherapy (SBRT) is delivered with considerably higher treatment fraction doses over a short span of time, usually __ to __ treatment days, in contrast to daily treatments for 5 days per week for 6 to 8 weeks for conventional EBRT.
1 to 5
GVHD may be acute, occurring within the first ___ days, or chronic, occurring after 100 days
100
Stomatitis affects up to ____% of patients undergoing high-dose chemotherapy with HSCT, ____% of patients with malignancies of the head and neck receiving radiotherapy, and up to ____% of patients receiving standard-dose chemotherapy
100 80 40
Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer and is usually defined as a platelet count less than ______________________________
100,000/mm3 (0.1 × 1012/L).
Educate clients as to signs and symptoms of infection and to report temperature over _______ immediately to the provider
100.4
Placing patient in private room if absolute WBC count <___________/mm3.
1000
about ________% of all cancers worldwide are linked to viral infections
11
educate on avoiding carcinogens (smoking), limiting alcohol and caloric intake and increasing activity level, using sunscreen with a minimum SPF of ____, limiting sun exposure and using condoms
15
What are the normal platelet counts?
150,000-400,000
Normal platelet count
150,000-400,000/mm3
Diagnosis of Cancer
1st. Determine presence, extent of tumor 2nd. Identify possible spread (metastasis) of disease or invasion of other body tissues 3rd. Evaluate function of involved, uninvolved body systems, organs 4th. Obtain tissue, cells for analysis, including evaluation of tumor stage, grade
Acute or early toxicities most often begin within ____ weeks of the initiation of treatment occur when normal cells within the treatment area are damaged and cellular death exceeds regeneration.
2
Hyperpigmentation, a less severe radiation-associated skin reaction, may develop about __ to __ weeks after the initiation of treatment
2 to 4
nonsmokers who live with a smoker have about a ____% to ____% greater risk of developing lung cancer
20% to 30%
Combination estrogen and progesterone therapy is linked to a higher risk of breast cancer. The longer the combined therapy is used, the higher the risk. However, within ____ years of stopping the hormones, the risk returns to that of a woman who never used this therapy.
3
Instruct patients to avoid sunlight through use of protective clothing, use of sun screen with SPF of ____ with physical blockers (zinc oxide, titanium dioxide), or avoidance of direct sun exposure.
30
Anthracyclines (e.g., daunorubicin, doxorubicin) are known to cause irreversible cumulative cardiac toxicities, especially when total dosage reaches ______ mg/m2 and _____ mg/m2, respectively
300 550
At what age should someone receive a baseline mammogram?
40, unless history of breast cancer, then baseline should be at 30 y/o
normal white blood cell count
5,000-10,000
What level of SPF should be used to help prevent skin cancer?
50 SPF
For certain chemotherapeutic agents, there is a maximum lifetime dose limit that must be adhered to because of the danger of long-term irreversible organ complications (e.g., because of the risk of cardiomyopathy, doxorubicin [Adriamycin] has a cumulative lifetime dose limit of _______ mg/m2).
550
_____% of all cancer diagnoses are in people 55 years of age or older.
78
Normal calcium levels
8.5-10.5 mg/dL
The lethal tumor dose is defined as the dose that will eradicate ______% of the tumor yet preserve normal tissue.
95
A patient is prescribed telithromycin 800 mg orally for community-acquired pneumonia. Prior to administering the medication, the nurse reviews the patient's laboratory values. Which of the following laboratory values would recommend a reduction in dosage to 400 mg? (Select all that apply.) A. creatinine, 3.3 mg per dL B. alanine aminotransferase, 98 units per L C. aspartate aminotransferase, 60 units per L D. sodium, 145 mEq per L
A, B, and C. The creatinine, alanine aminotransferase, and aspartate aminotransferase are all elevated, indicating diminished renal and hepatic function. It is necessary to reduce the telithromycin dosage in the presence of renal and hepatic impairment.
The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breath and the nurses rapid assessment reveals that the patients jugular veins are distended. The nurse should suspect the development of what oncologic emergency? A) Increased intracranial pressure B) Superior vena cava syndrome (SVCS) C) Spinal cord compression D) Metastatic tumor of the neck
Ans: B Feedback: SVCS occurs when there is gradual or sudden impaired venous drainage giving rise to progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling; edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing; as well as possibly engorged and distended jugular, temporal, and arm veins. Increased intracranial pressure may be a part of SVCS, but it is not what is causing the patients symptoms. The scenario does not mention a problem with the patients spinal cord. The scenario says that the cancer has metastasized, but not that it has metastasized to the neck.
A teenage boy receives a prescription for erythromycin for an upper respiratory tract infection. He complains that he cannot hear the teacher, who then sends him to the school nurse's office. After assessing the patient's hearing with a tuning fork, the nurse determines that his hearing is diminished. What is the most important nursing intervention? A. The nurse should notify the parents to call the physician; this is an adverse effect of erythromycin. B. The nurse should inform the parents of a physician who specializes in ear, nose, and throat surgery. C. The nurse should instruct the patient to stop taking the erythromycin and his hearing will improve. D. The nurse should call the physician and inform the patient of a change in antibiotics.
A. After the nurse assesses the patient's hearing, it is important to notify the patient's family of the hearing loss and tell the parents to notify the physician, because this is an adverse effect of erythromycin. The nurse does not have the authority to discontinue the erythromycin but needs to play a role in notifying the prescriber of the hearing loss.
A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states, They tell me my cancer is malignant, while my coworkers breast tumor was benign. I just dont understand at all. When preparing a response to this patient, the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type? A) Slow rate of mitosis of cancer cells B) Different proteins in the cell membrane C) Differing size of the cells D) Different molecular structure in the cells
Ans: B Feedback: The cell membrane of malignant cells also contains proteins called tumor-specific antigens (e.g., carcinoembryonic antigen [CEA] and prostate-specific antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type.
In explaining antineoplastic therapy to a family member of a patient who is to receive treatment with a cytotoxic drug, the nurse explains that it... A. damages both malignant and nonmalignant cells B. causes few adverse effects C. stimulates growth of cancer cells D. must be given daily
A. Cytotoxic drugs damage both normal and malignant cells and may cause severe adverse effects. They block or slow cancer cell growth rather than stimulating it. Administration of most of the drugs is cyclical, with cycles of a few days, then a few weeks without the drugs, then a repeat cycle as opposed to daily administration.
Which of the following classes of cephalosporins has the best activity against gram-positive organisms? A. first-generation cephalosporins B. second-generation cephalosporins C. third-generation cephalosporins D. fourth-generation cephalosporins
A. First-generation cephalosporins are primarily effective against gram-positive bacteria. Second-generation cephalosporins are more active against gram-negative bacteria than first-generation drugs. Third-generation cephalosporins further extend the spectrum of activity against gram-negative organisms. Fourth-generation cephalosporins are the broadest of all in spectrum acting against some gram-positive and many gram-negative organisms, including greater stability against degradation by beta-lactamase enzymes.
A woman develops a urinary tract infection following the delivery of an infant. The nurse practitioner is considering prescribing trimethoprim-sulfamethoxazole. What assessment is necessary to make? A. if the woman is breast-feeding B. if the woman has been treated with the medication in the past C. if anyone in her family has a known allergy to the drug D. if she is experiencing hematuria
A. It is important to assess if the woman is breast-feeding. If a fetus or young infant receives a sulfonamide by placental transfer, in breast milk, or by direct administration, the drug displaces bilirubin from binding sites on albumin. As a result, bilirubin may accumulate in the bloodstream (hyperbilirubinemia) and central nervous system (kernicterus), causing life-threatening toxicity.
Hormone inhibitor drugs used in the treatment of cancer are most effective in... A. treating breast or prostate cancer B. preventing hematological malignancies C. treating thyroid and pituitary tumors D. protecting normal cells from cytotoxic drugs
A. Malignant tumors of the breast, uterus, ovary, and prostate are influenced by hormones. Sex hormones act as growth factors in some malignancies. For example, some breast tumors have estrogen receptors, whereas prostate cancer in men grows under stimulation by testosterone. Hormone inhibitors slow the growth of cancer cells stimulated by hormones.
A physician writes an order for gentamicin 7 mg per kg intravenously every 24 hours and ampicillin 500 mg intravenously every 6 hours. The patient has a diagnosis of endocarditis. This is not an ideal antibiotic regimen for endocarditis because... A. it is best to use multiple daily dosing of gentamicin for endocarditis B. the addition of gentamicin to ampicillin increases the risk of treatment failure in endocarditis C. the appropriate single daily dose of gentamicin is 15 mg per kg once daily D. streptomycin is the recommended aminoglycoside for use in endocarditis
A. Once-daily aminoglycoside dosing is contraindicated in patients with endocarditis, and only the conventional dosing regimen should be used. B is incorrect because gentamicin and ampicillin are recommended in endocarditis, and they increase the risk of treatment success, not failure. C is incorrect because the single daily dose of gentamicin is a maximum of 7 mg/kg, not 15 mg/kg, once daily. D is incorrect because streptomycin is not the recommended aminoglycoside for use in endocarditis.
An oncology nurse educator is providing health education to a patient who has been diagnosed with skin cancer. The patients wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite? A) Malignant cells contain more fibronectin than normal body cells. B) Malignant cells contain proteins called tumor-specific antigens. C) Chromosomes contained in cancer cells are more durable and stable than those of normal cells. D) The nuclei of cancer cells are unusually large, but regularly shaped.
Ans: B Feedback: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.
The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient? A) Fatigue related to altered metabolic processes B) Altered nutrition: less than body requirements related to anorexia C) Risk for infection related to altered immunologic response D) Body image disturbance related to weight loss and anorexia
Ans: C Feedback: A priority nursing diagnosis for this patient is risk for infection related to altered immunologic response. Because the patients immunity is suppressed, he or she will be at a high risk for infection. The other listed nursing diagnoses are valid, but they are not as high a priority as is risk for infection.
The school nurse is teaching a nutrition class in the local high school. One student states that he has heard that certain foods can increase the incidence of cancer. The nurse responds, Research has shown that certain foods indeed appear to increase the risk of cancer. Which of the following menu selections would be the best choice for potentially reducing the risks of cancer? A) Smoked salmon and green beans B) Pork chops and fried green tomatoes C) Baked apricot chicken and steamed broccoli D) Liver, onions, and steamed peas
Ans: C Feedback: Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited.
A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia? A) Interrupted sleep pattern B) Hot flashes C) Epistaxis (nose bleed) D) Increased weight
Ans: C Feedback: Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.
An oncology patient has just returned from the postanesthesia care unit after an open hemicolectomy. This patients plan of nursing care should prioritize which of the following? A) Assess the patient hourly for signs of compartment syndrome. B) Assess the patients fine motor skills once per shift. C) Assess the patients wound for dehiscence every 4 hours. D) Maintain the patients head of bed at 45 degrees or more at all times.
Ans: C Feedback: Postoperatively, the nurse assesses the patients responses to the surgery and monitors the patient 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.
For a patient receiving a cytotoxic drug that will likely result in bone marrow depression, which of the following teaching considerations should be the priority for the nurse with the patient and family members or caregivers? A. Wash hands often and avoid people with colds, flu, or other infections. B. Do not expect fatigue and weakness, which are uncommon. C. Expect gastrointestinal upset. More nausea and vomiting may occur when the blood cell counts are low. D. Take acetaminophen for fever.
A. Patients receiving a drug that depresses bone marrow function are at high risk of developing serious infections. Every effort should be made to prevent infections in the patient. Although the patient may be included in the vigilance necessary to make sure that those in proximity understand precautions, it is especially important that this be communicated to all others in the patient's environment. Fatigue and weakness also often occur with bone marrow depression and require medical monitoring. There is no particular correlation between nausea and vomiting and blood cell counts. Any fever should be reported, and antibiotics are given rather than antipyretics.
The nurse instructs a patient on the administration of clarithromycin. Which of the following patient teaching instructions is appropriate? A. Take the medication on an empty stomach. B. Take the medication with a calcium supplement. C. Take the medication with a class of milk. D. Take the medication with cheese.
A. Patients should take azithromycin on an empty stomach. The other choices all involve combination with a calcium-containing substance, which should not be administered with azithromycin.
Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention? A) Yearly Pap tests B) Testicular self-examination C) Teaching patients to wear sunscreen D) Screening mammograms
Ans: C Feedback: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.
The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A) Salvage surgery B) Palliative surgery C) Prophylactic surgery D) Reconstructive surgery
Ans: C Feedback: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.
A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity? A) Disease prophylaxis B) Risk reduction C) Secondary prevention D) Tertiary prevention
Ans: C Feedback: Secondary prevention involves screening and early detection activities that seek to identify early stage cancer in individuals who lack signs and symptoms suggestive of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the patient after having been diagnosed with cancer.
A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic? A) Smoking is the reason you are here. B) The doctor left orders for you not to smoke. C) You are anxious about the surgery. Do you see smoking as helping? D) Smoking is OK right now, but after your surgery it is contraindicated.
Ans: C Feedback: Stating You are anxious about the surgery. Do you see smoking as helping? acknowledges the patients feelings and encourages him to assess his previous behavior. Saying Smoking is the reason you are here belittles the patient. Citing the doctors orders does not address the patients anxiety. Sanctioning smoking would be highly detrimental to this patient.
A nurse is preparing to administer the first dose of piperacillin-tazobactam (Zosyn) to a patient in an infusion clinic. The nurse should take which of the following precautions? A. Ask the patient about past allergic reactions to penicillins. B. Ask the patient about past allergic reactions to aminoglycosides. C. Mix the piperacillin-tazobactam with lidocaine to reduce pain of infusion. D. Instruct the patient to eat a snack to decrease stomach upset from piperacillin-tazobactam
A. Penicillin allergy is the most common cause of drug-induced anaphylaxis. Piperacillin-tazobactam (Zosyn) is a combination product containing an extended-spectrum antipseudomonal penicillin and a beta-lactamase inhibitor. Cross-allergenicity occurs among all the penicillins; therefore, asking the patient about past reactions to penicillins is a necessary intervention before giving this medication. Drug administration is intravenous; thus, it is unlikely to cause stomach upset. After diluting the drug in intravenous fluid, administration occurs slowly through a small-bore needle in a large vein to prevent vein irritation and pain during infusion. It is important to monitor the site and ensure that it remains patent throughout the administration.
Which of the following foods should not be taken with tetracycline? A. orange juice with calcium B. cranberry juice cocktail C. tomato juice D. lemonade
A. Tetracycline is contraindicated with calcium or dairy products.
Which laboratory value should the nurse assess in patients who are receiving demeclocycline? A. blood urea nitrogen B. aspartate aminotransferase C. alanine aminotransferase D. creatinine
A. When administering demeclocycline, it is important to monitor the patient's blood urea nitrogen (BUN). Increases in the BUN are secondary to antianabolic Effect
A man has had a urinary tract infection, and a prescriber orders phenazopyridine (Pyridium). Which of the following adverse effects should he report to his health care provider? A. yellowing of the skin B. edema C. pain D. malaise
A. Yellowing of the skin indicates an accumulation of phenazopyridine.
Indications of extravasation during administration of vesicant agents include the following:
Absence of blood return from the IV catheter Resistance to flow of IV fluid Burning or pain, swelling, or redness at the site * An extravasation kit should be readily available with emergency equipment and antidote medications
acude side effects Hematopoietic Stem Cell Transplantation
Acute side effects include alopecia, hemorrhagic cystitis, nausea, vomiting, diarrhea, encephalopathy, pulmonary edema, acute kidney injury, fluid and electrolyte imbalances, and severe mucositis
There is maximum lifetime dosage limits with certain chemo agents due to irreversible organ damage such as with __________ which causes cardiomyopathy.
Adriamycin
Epothilones: ixabepilone (Ixempra) *Cell cycle—specific (M phase)
Alters microtubules and inhibits mitosis
__________ has demonstrated an ability to minimize renal toxicities associated with cisplatin, cyclophosphamide (Cytoxan), and ifosfamide (Ifex) therapy.
Amifostine
Give me an example of a hereditary gene associated with cancer.
An example would include hereditary breast and ovarian cancer syndrome (BRCA1 and BRCA2).
TNM Classification System
An international system for determining the extent of metastasis and the level of cell differentiation, two important factors in treatment and prognosis of cancer.
Genetic tumor markers (Also called prognostic indicators)
Analysis for the presence of mutations (alterations) in genes found in tumors or body tissues. Assists in diagnosis, selection of treatment, prediction of response to therapy, and risk of progression or recurrence
The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient? A) Impaired nutritional status B) Cognitive changes C) Diarrhea D) Alopecia
Ans: A Feedback: Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The patient is at an increased risk of impaired nutritional status. Radiotherapy does not cause cognitive changes. Diarrhea is not a likely concern for this patient. Radiation only results in alopecia when targeted at the whole brain; radiation of other parts of the body does not lead to hair loss.
A 50-year-old man diagnosed with leukemia will begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy? A) Administer an antiemetic. B) Administer an antimetabolite. C) Administer a tumor antibiotic. D) Administer an anticoagulant.
Ans: A Feedback: Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to 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.
While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action? A) Stopping the administration of the drug immediately B) Notifying the patients physician C) Continuing the infusion but decreasing the rate D) Applying a warm compress to the infusion site
Ans: A Feedback: Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patients physician. Ice can be applied to the site once the drug therapy has stopped.
The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient? A) These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies. B) These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer. C) Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy. D) Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying.
Ans: A Feedback: Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and should not be belittled. Radiation destroys both cancerous and normal cells.
A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem? A) The patient requests that her family bring her makeup and wig. B) The patient begins to discuss the future with her family. C) The patient reports less disruption from pain and discomfort. D) The patient cries openly when discussing her disease.
Ans: A Feedback: Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they do not necessarily indicate improved body image and self-esteem.
The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurses assessment should include examination for the signs and symptoms of what complication? A) Tumor lysis syndrome (TLS) B) Syndrome of inappropriate antiduretic hormone (SIADH) C) Disseminated intravascular coagulation (DIC) D) Hypercalcemia
Ans: A Feedback: TLS is a potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small cell lung cancer. DIC, SIADH and hypercalcemia are less likely complications following this treatment and diagnosis.
The hospice nurse has just admitted a new patient to the program. What principle guides hospice care? A) Care addresses the needs of the patient as well as the needs of the family. B) Care is focused on the patient centrally and the family peripherally. C) The focus of all aspects of care is solely on the patient. D) The care team prioritizes the patients physical needs and the family is responsible for the patients emotional needs.
Ans: A Feedback: The focus of hospice care is on the family as well as the patient. The family is not solely responsible for the patients emotional well-being
A 60-year-old patient with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this patients subsequent plan of care? A) Limit the time that visitors spend at the patients bedside. B) Teach the patient to perform all aspects of basic care independently. C) Assign male nurses to the patients care whenever possible. D) Situate the patient in a shared room with other patients receiving brachytherapy.
Ans: A Feedback: To limit radiation exposure, visitors should generally not spend more than 30 minutes with the patient. Pregnant nurses or visitors should not be near the patient, but there is no reason to limit care to nurses who are male. All necessary care should be provided to the patient and a single room should be used.
You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A) Palliative B) Reconstructive C) Salvage D) Prophylactic
Ans: A Feedback: When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote quality of life as defined by the patient and his or her family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.
A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patients skin appears yellow. Which blood tests should be done to further explore this clinical sign? A) Liver function tests (LFTs) B) Complete blood count (CBC) C) Platelet count D) Blood urea nitrogen and creatinine
Ans: A Feedback: Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.
You are caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What actions should you encourage the patient 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.
Ans: A, C, D Feedback: Stomatitis is an inflammation of the oral cavity. The patient should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.
The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A) Rate of growth B) Ability to cause death C) Size of cells D) Cell contents E) Ability to spread
Ans: A,B,E Feedback: Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are basically the same, but they behave differently.
The hospice nurse is caring for a patient with cancer in her home. The nurse has explained to the patient and the family that the patient is at risk for hypercalcemia and has educated them on that signs and symptoms of this health problem. What else should the nurse teach this patient and family to do to reduce the patients risk of hypercalcemia? A) Stool softeners are contraindicated. B) Laxatives should be taken daily. C) Consume 2 to 4 L of fluid daily. D) Restrict calcium intake.
Ans: C Feedback: The nurse should identify patients at risk for hypercalcemia, assess for signs and symptoms of hypercalcemia, and educate the patient and family. The nurse should teach at-risk patients to recognize and report signs and symptoms of hypercalcemia and encourage patients to consume 2 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease. Also, the nurse should explain the use of dietary and pharmacologic interventions, such as stool softeners and laxatives for constipation, and advise patients to maintain nutritional intake without restricting normal calcium intake.
The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurses interview with the patient, she admits that she drinks around 20 ounces of vodka every evening. What types of cancer does this put her at risk for? Select all that apply. A) Malignant melanoma B) Brain cancer C) Breast cancer D) Esophageal cancer E) Liver cancer
Ans: C, D, E Feedback: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.
An oncology nurse is contributing to the care of a patient who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRFs). The nurse should know that these achieve a therapeutic effect by what means? A) Promoting the synthesis and release of leukocytes B) Focusing the patients immune system exclusively on the tumor C) Potentiating the effects of chemotherapeutic agents and radiation therapy D) Altering the immunologic relationship between the tumor and the patient
Ans: D Feedback: BRFs alter the immunologic relationship between the tumor and the cancer patient (host) to provide a therapeutic benefit. They do not necessarily increase white cell production or focus the immune system solely on the tumor. BRFs do not potentiate radiotherapy and chemotherapy.
A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patients family and friends? A) Your family should likely gather at the bedside in case theres a negative outcome. B) Make sure she doesnt eat any food in the 24 hours before the procedure. C) Wear a hospital gown when you go into the patients room. D) Do not visit if you've had a recent infection.
Ans: D Feedback: Before HSCT, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the patients contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside.
An oncology nurse is caring for a patient who has developed erythema following radiation therapy. What should the nurse instruct the patient to do? A) Periodically apply ice to the area. B) Keep the area cleanly shaven. C) Apply petroleum jelly to the affected area. D) Avoid using soap on the treatment area.
Ans: D Feedback: Care to the affected area must focus on preventing further skin irritation, drying, and damage. Soaps, petroleum ointment, and shaving the area could worsen the erythema. Ice is also contraindicated.
The nurse is caring for a patient has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patients care needs are unable to be met in a home environment. What might you suggest as an alternative? A) Discuss a referral for rehabilitation hospital. B) Panel the patient for a personal care home. C) Discuss a referral for acute care. D) Discuss a referral for hospice care.
Ans: D Feedback: Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the patient and family. Patients who are referred to hospice care generally have fewer than 6 months to live. Each of the other listed options would be less appropriate for the patients physical and psychosocial needs.
An oncology patient will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another? A) Adhering to primary tumor cells B) Inducing mutation of cells of another organ C) Phagocytizing healthy cells D) Invading healthy host tissues
Ans: D Feedback: Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.
An oncology patient has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis? A) Apply an ice pack or heating pad PRN to relieve pain and pruritis B) Avoid skin contact with water whenever possible C) Apply phototherapy PRN D) Avoid rubbing or scratching the affected area
Ans: D Feedback: Rubbing and or scratching will lead to additional skin irritation, damage, and increased risk of infection. Extremes of hot, cold, and light should be avoided. No need to avoid contact with water.
A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo? A) Lymphadenectomy B) Needle biopsy C) Open biopsy D) Sentinel node biopsy
Ans: D Feedback: Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer.
The nurse is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, what action should the nurse emphasize? A) Adjust the dose to the patients present symptoms. B) Wash hands with an alcohol-based cleanser following administration. C) Use gloves and a lab coat when preparing the medication. D) Dispose of the antineoplastic wastes in the hazardous waste receptacle.
Ans: D Feedback: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Dosages are not adjusted on a short-term basis. Hand and arm hygiene must be performed before and after administering the medication.
Mitotic Spindle Inhibitors
Arrest metaphase by inhibiting mitotic tubular formation (spindle); inhibit DNA and protein synthesis *Cell cycle—specific (M phase)
Taxanes (Paclitaxel, Docetaxel)
Arrest metaphase by inhibiting tubulin depolymerization *Cell cycle—specific (M phase)
In acute renal failure, doses of which of the following antibiotics must be reduced? (Check all that apply.) A. nafcillin B. cefazolin C. meropenem D. aztreonam
B, C, and D. Cefazolin, meropenem, and aztreonam all rely on renal clearance, and their dosages must be reduced in acute renal failure. The elimination of nafcillin does not entirely rely on renal clearance, because it is 60% metabolized by the liver.
A woman is to receive amoxicillin-clavulanate (Augmentin) 500 mg PO every 8 hours for bronchitis. The nurse retrieves two 250-mg tablets from the medication cart. This is incorrect for which of the following reasons? A. The amount of sulbactam in amoxicillin-clavulanate 250 mg is 62.5 mg per tablet, twice the intended amount. B. This provides twice the intended dose of clavulanate. C. The 250-mg tablets have less absorption than the 500-mg tablets. D. Administration of amoxicillin-clavulanate is only intravenous, so selecting tablets means that the wrong drug is being administered.
B. Amoxicillin-clavulanate (Augmentin) is an orally administered combination product containing the antibiotic amoxicillin and the beta-lactamase inhibitor clavulanate. It is available in 250-, 500-, and 875-mg tablets; each of which contains 125 mg of clavulanate. Administering two 250-mg tablets of Augmentin provides an overdosage (250 mg) of clavulanate.
A nurse working in the neurointensive care unit is caring for a patient with a head injury who has been experiencing seizures and now has pneumonia caused by Pseudomonas aeruginosa. The physician has prescribed imipenem 1 g IV every 6 hours plus gentamicin for the pneumonia. Before administering the antibiotics, the nurse should do which of the following? A. Avoid mixing the imipenem and gentamicin in the same IV bag to prevent inactivation of the gentamicin. B. Remind the physician of the patient's seizures and inquire whether a different antibiotic might be safer. C. Suggest to the physician that imipenem is used to treat gram-positive infections and will not be effective in this patient. D. Set the infusion pump to deliver the imipenem over 15 minutes.
B. An adverse effect of imipenem is central nervous system toxicity including seizures, which is undesirable for this patient with a head injury and seizure activity. Although imipenem may be given concomitantly with gentamicin, mixing these drugs together in the same IV fluid inactivates the gentamicin. Imipenem is a broad-spectrum antibiotic that should be infused over 40 to 60 minutes.
A nurse reading a patient's chart notices that the patient is scheduled to receive ciprofloxacin 500 mg PO at 9:00 AM. The medication administration record also indicates that Maalox 30 mL PO and hydrochlorothiazide 25 mg PO are due at 9:00 AM. The nurse should... A. administer all the medications as scheduled B. hold the Maalox until 11:00 AM C. ask the physician to discontinue hydrochlorothiazide because of increased risk of ototoxicity D. administer the Maalox and ciprofloxacin but hold the hydrochlorothiazide
B. Ciprofloxacin can chelate with cations, and iron, multivitamins, calcium, magnesium, aluminum salts, and sucralfate may significantly reduce the absorption of ciprofloxacin. Therefore, ciprofloxacin should be taken 2 hours before or 6 hours after administration of the other agents. A is incorrect because Maalox impairs the absorption of ciprofloxacin. C is incorrect because loop diuretics, not thiazide diuretics, potentiate the effects of nephrotoxicity. D is incorrect because of the interaction with Maalox and ciprofloxacin. Thiazide diuretics do not interact with ciprofloxacin like loop diuretics do.
A critically ill patient is receiving gentamicin 1.5 mg per kg intravenously every 8 hours. The patient has recently stopped making urine, and the most recent laboratory results indicate that the patient's creatinine level has risen from a normal value of 0.8 mg per dL to 3.6 mg per dL. At the next scheduled time for administration of gentamicin, the nurse should A. administer half the prescribed dose B. hold the gentamicin and notify the physician C. administer gentamicin as prescribed D. draw a blood sample for testing the gentamicin trough level before the dose and then administer as prescribed
B. Gentamicin is excreted via the kidneys, and alterations in renal function may cause nephrotoxicity. Possible nephrotoxicity is a well-known adverse effect of gentamicin, and in this case, the nurse should notify the physician. A and C are incorrect because the patient could be experiencing renal impairment, and giving more gentamicin, even half the dose, may still cause drug toxicity and nephrotoxicity. D is incorrect because gentamicin could be contributing to the renal impairment. Although obtaining a trough level might help evaluate the gentamicin regimen, the nurse should not administer the drug until he or she discusses it with the physician.
A vesicant antineoplastic drug does which of the following? A. It causes minor skin irritation. B. It causes extensive tissue damage. C. It requires administration only through a central IV line. D. It requires deep intramuscular injection if diluted with normal saline.
B. Leakage of a vesicant drug into tissues surrounding the venipuncture site can cause severe tissue damage, which should be prevented if possible. Drug administration is often at a peripheral IV site, although it may occur via central line. Intramuscular administration is never appropriate.
A priority nursing diagnosis to include in the care plan for a patient receiving cytotoxic chemotherapy is... A. Risk for Impaired Skin Integrity B. Risk for Injury: Infection C. Body Image Disturbance related to alopecia D. Ineffective Family Coping
B. Most cytotoxic antineoplastic drugs suppress bone marrow function, including production of white blood cells that normally fight infectious microorganisms. Although impaired skin integrity, body image disturbance, and ineffective family coping may also be appropriate nursing diagnoses for particular patients, they are not as important as the risk of infection.
A patient is admitted to the emergency department following opening an envelope containing a substance that experts have identified as anthrax. Which of the following medications is administered? A. tetracycline B. doxycycline C. amoxicillin-clavulanic acid combination D. neomycin
B. Patients who are asymptomatic receive doxycycline or ciprofloxacin for 60 days following exposure to anthrax.
A cardiac surgeon orders cefazolin 1 g IV "on call" to the operating room for a patient scheduled for a heart valve replacement. The surgery is scheduled for 7:00 AM the next morning. What is the rationale for giving the antibiotic at 6:30 AM? The last dose was administered more than 8 hours ago. A. The cefazolin must be given 60 minutes before the procedure for legal reasons. B. The cefazolin must be given within 60 minutes before the first skin incision to reach therapeutic concentrations. C. The cefazolin trough level will be checked at 6:00 AM, which would allow the level to come back before administration of the "on call" dose. D. The last dose was administered yesterday.
B. Research has demonstrated that antibiotics must be present in the patient when the first skin incision to provide the most protection against infections acquired during surgery. That means that most antibiotics are ideally given no more than 1 hour before, not after, the first skin incision.
Which of the following adverse effects of telithromycin indicates a superinfection? A. diarrhea B. bloody diarrhea C. nausea D. vomiting
B. The development of bloody diarrhea is a symptom of pseudomembranous colitis, which is a superinfection.
A female patient with chronic lymphocytic leukemia is beginning to receive an oral cyclophosphamide. The nurse instructs the patient that the best way to take the drug is... A. with food B. on an empty stomach C. at bedtime D. one hour after a meal
B. The nurse tells the patient to take the oral cyclophosphamide on an empty stomach. If severe gastrointestinal upset occurs, she should take the drug with food.
A man is receiving treatment for a Mycoplasma pneumoniae infection. He says that drinking orange juice hurts his mouth. What priority assessment should the nurse make? A. Assess the patient's fecal output for signs and symptoms of diarrhea. B. Assess the patient's mouth for signs of candidal infection. C. Assess the patient's lung sounds for rales or rhonchi. D. Assess the patient's intake and output.
B. When a patient complains of mouth pain and difficulty swallowing when taking an antiinfective agent such as tetracycline, it is necessary to inspect the patient's mouth for white patchy areas. These areas indicate Candida albicans, a superinfection of the mouth.
A nurse is applying silver sulfadiazine (Silvadene) to a child's burns. Which of the following nursing actions is most important when applying the medication? A. providing pain medication B. using sterile gloves C. giving the child a bath D. teaching the parent to apply the medication
B. When applying silver sulfadiazine (Silvadene) to a burned area, it is important to wear sterile gloves.
A physician has ordered sulfisoxazole for a woman with a urinary tract infection. The nurse has asked the patient about whether she takes any over-the-counter medications. The patient reports that she regularly takes St. John's wort as a mood elevator. Which of the following patient teaching interventions is most important? A. Taking St. John's wort and sulfisoxazole results in no known interactions. B. Sulfisoxazole combined with St. John's wort leads to an increased therapeutic effect of the sulfisoxazole. C. Sulfisoxazole has a decreased effect when given with St. John's wort. D. When given in combination, sulfisoxazole and St. John's wort result in manic tendencies.
B. When taken concurrently with sulfisoxazole, St. John's wort enhances the effects of the sulfisoxazole.
Alkylating Agents
Bond with DNA, RNA, and protein molecules leading to impaired DNA replication, RNA transcription, and cell functioning * all resulting in cell death
Topoisomerase I Inhibitors side effects
Bone marrow suppression, diarrhea, nausea, vomiting, flulike symptoms (topotecan), rash (etoposide), hepatotoxicity (teniposide)
Alkylating agents common Side Effects:
Bone marrow suppression, nausea, vomiting, cystitis (cyclophosphamide, ifosfamide), stomatitis, alopecia, gonadal suppression, renal toxicity (cisplatin), and development of secondary malignancies
Throbbing and aching pain
Bone metastasis
__________________ is the placement of radioactive sources within or immediately next to the cancer site in order to provide a highly targeted, intense dose of radiation beyond a dose that is usually provided by EBRT. In addition, this form of radiation delivery helps to spare exposure to normal surrounding tissue.
Brachytherapy
A man had rheumatic fever as a child. He has an appointment for a tooth extraction. His dentist prescribes which of the following medications prior to the extraction? A. chloramphenicol B. vancomycin C. clarithromycin D. digoxin
C. Clarithromycin is the prophylactic drug of choice for patients who are predisposed to cardiac endocarditis. Patients who have had rheumatic fever are at risk for the development of this infectious cardiac condition.
A patient is admitted to the critical care unit with a diagnosis of Legionnaire's disease. Based on your knowledge of pharmacology, which medication is the drug of choice to treat the infection? A. azithromycin B. clarithromycin C. erythromycin D. vancomycin
C. Parenteral erythromycin is the drug of choice for the treatment of Legionnaire's disease.
A patient from a nursing home arrives at the emergency department with acute pyelonephritis. The physician prescribes ciprofloxacin 500 mg PO twice daily. The patient has a history of seizures and bradycardia. The nurse should... A. counsel the patient's caregiver to avoid administering the ciprofloxacin with the patient's anticonvulsant B. ask the physician to check blood levels of the patient's anticonvulsant(s) before giving the first dose of ciprofloxacin C. call the patient's seizure and dysrhythmia history to the physician's attention and inquire whether another type of antibiotic might be selected D. counsel the patient's caregiver to discontinue the ciprofloxacin after the patient's fever is gone
C. The addition of ciprofloxacin has led to documented drug interactions with anticonvulsants and antidysrhythmics, and the prescriber should choose an alternative if possible. A is incorrect because the patient needs to take the anticonvulsant for seizures as well as an antibiotic for pyelonephritis. Altering the administration schedule may precipitate seizures. B is incorrect because even if levels are obtained, it is the concurrent administration ciprofloxacin that can alter the levels of the anticonvulsant. In addition, an interaction with the antidysrhythmic agent may prolong the QT interval. D is incorrect because all antibiotics should be taken for the entire duration of therapy, even if the patient feels better or the fever is gone.
A college student is seen in the campus health center with a sore throat. Examination of the throat reveals redness and swelling but no sign of infection. Which of the following is an accurate description of the inflammatory process? A. A granuloma will develop if the inflammation is unresolved. B. The student is not at risk for the development of an infection. C. There is an influx of leukocytes to the throat. D. Scarring will result from phagocytic action.
C. The presence of inflammation initiates the influx of leukocytes to the area of inflammation to assist in tissue repair.
A physician has ordered intravenous sulfamethoxazole with trimethoprim. How should the nurse administer the medication? A. in 500 mL of 0.45% normal saline B. in 150 mL of 10% dextrose and water C. in 125 mL of 5% dextrose and water D. in 125 mL of 5% dextrose and 0.45% normal saline
C. When administering sulfamethoxazole and trimethoprim intravenously, it is necessary to dilute the medication in 125 mL of 5% dextrose and water.
Why does the immunocompromised client have an increased incidence of cancer?
Cancer develops when the immune system fails to recognize and destroy abnormal cells--Therefore patients who are immunocompromised have an increased incidence of cancer
Account for 80-90% of all cancers
Carcinoma
Carcinoembryonic antigen
Carcinomas of the colon, pancreas, lung, stomach, and heart
Why is cefazolin the drug of choice for his cardiac pacemaker procedure?
Cefazolin is the drug of choice for surgical prophylaxis in most surgical procedures.
Use of chemicals or chemotherapy applied directly to tissue to cause destruction
Chemosurgery
___________ involves the use of antineoplastic drugs in an attempt to destroy cancer cells by interfering with cellular functions, including replication and DNA repair
Chemotherapy
leucovorin (Wellcovorin)
Chemotherapy modulating agent *Adjunct Chemotherapeutic Agents
Use of narrow-beam x-ray to scan successive layers of tissue for a cross-sectional view
Computed tomography (CT) scan
approach for managing CINV
Corticosteroids, phenothiazines, sedatives, and histamines are helpful * especially when used in combination with serotonin blockers to provide antiemetic protection
Use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction
Cryoablation * Cervical, prostate, and rectal cancers
substances produced primarily by cells of the immune system to enhance or suppress the production and functioning of components of the immune system, are used to treat cancer or the adverse effects of some cancer treatments.
Cytokines
A nurse practitioner has prescribed nitrofurantoin (Macrodantin) for a woman with a urinary tract infection. Which of the following cardiovascular adverse effects is this patient at risk for developing? A. inverted T wave B. widened QRS C. premature ventricular contraction (PVC) D. bundle branch block
D. Bundle branch block and changes in the ST and T waves are cardiac-related adverse effects of nitrofurantoin.
A parent of a high school student calls the school nurse regarding her daughter's crying. The parent states that this behavior is unusual for her daughter. Which of the following medications contributes to changes in behavior? A. metronidazole B. naproxen sodium C. vitamin C D. erythromycin
D. Changes in behavior with crying or laughing is an adverse effect of erythromycin.
A sputum specimen report from the laboratory states, "Contamination with typical oral flora." Which interpretation is correct? A. Bacteria in the mouth are growing in the lungs. B. The normal flora has become pathogenic. C. The patient has a pulmonary infection. D. The sputum from the lungs has mixed with bacteria in the mouth.
D. Normal or typical flora refers to microbe that normally resides in a body region. When the sputum specimen was obtained, a relatively large amount of oral secretions were expectorated into the specimen container taking with it normal flora from the mouth. To avoid this, the nurse will have the patient rinse the mouth out well prior to collecting a sputum specimen and will give clear instructions to the patient to cough deeply in order to obtain a specimen of pulmonary secretions rather than oral secretions.
An outpatient has just received a prescription for ciprofloxacin 500 mg PO twice daily for acute bronchitis. The nurse should teach the patient... A. not to take ciprofloxacin with a meal B. to restrict fluid intake to avoid fluid overload C. to take ciprofloxacin with an antacid (e.g., Tums) to decrease the chance of stomach upset D. to avoid prolonged exposure to sunlight
D. Photosensitivity may occur with exposure to direct or indirect sunlight; therefore, the patient should avoid prolonged exposure to the sun. Sunscreens do not prevent photosensitivity reactions. A is incorrect because patients may take ciprofloxacin with food to avoid gastrointestinal upset. B is incorrect because adequate fluid intake should accompany a ciprofloxacin dose to prevent drug crystals from forming in the urinary tract. C is incorrect because ciprofloxacin interacts with antacids, resulting in impaired ciprofloxacin absorption.
The nurse would prepare for what type of adverse effect in a client receiving imipenem-cilastatin who has a creatinine clearance =20 mL/min? A. Elevated liver function tests B. Rash C. Respiratory distress D. Seizure activity
D. Seizure activity risk also increases because the drug is excreted by the kidneys and this client's renal function is decreased. The nurse should prepare for possible seizure.
A patient receiving tetracycline should receive the following instruction regarding the medication? A. Take tetracycline with food. B. Take tetracycline in combination with antacids. C. Take the first dose and then obtain a test known as culture and sensitivity. D. Take tetracycline with a full glass of water.
D. Tetracycline should be taken with a full glass of water.
Torsade de pointes is a lengthened QT interval. Which of the following medications combined with telithromycin results in this condition? A. acetaminophen B. naproxen sodium C. regular insulin D. ciprofloxacin
D. The combination of ciprofloxacin and telithromycin leads to a prolonged QT wave.
When administering a sulfonamide, which of the following interventions is most effective in decreasing crystalluria? A. administering 8 ounces of cranberry juice B. providing a full liquid diet during the course of drug therapy C. inserting a Foley catheter for the measurement of an accurate intake and output D. providing a minimum of 2000 mL of fluid per day
D. To prevent crystalluria, it is essential that patients receive 2000 mL of fluids in a 24-hour period.
The nurse is caring for a client who has an indwelling Foley catheter. What nursing interventions will help prevent a urinary tract infection in this client? (Select all that apply.) A. Disconnect the catheter system to drain the urine from the drainage bag. B. Irrigate the Foley catheter three times a day. C. Leave the catheter in for at least 3 weeks. D. Keep the urinary drainage bag below the level of the client's bladder. E. Perform perineal care frequently.
D. and E. "Irrigate the Foley catheter three times a day" The sterility of the catheter/collection apparatus should not be broken unless there is a specific physician order to do so. Routine irrigation is not done.
After infecting individuals, DNA viruses insert a part of their own _______near the infected cell genes causing cell division. The newly formed cells that now carry viral DNA lack normal controls on growth
DNA
Replicating cells are most vulnerable to the disruptive effects of radiation, during _________ and _________, i.e., early S, G2, and M phases of the cell cycle. Therefore, those body tissues that undergo frequent cell division are most sensitive to radiation therapy.
DNA synthesis and mitosis
a patients receiving thoracic irradiation for lung cancer may experience acute esophageal irritation—associated chest pain and dysphagia. why this happens?
Depending on the targeted region, any portion of the gastrointestinal mucosa may be involved, causing mucositis (inflammation of the lining of the mouth, throat, and gastrointestinal tract)
Endoscopy
Direct visualization of a body cavity or passageway by insertion of an endoscope into a body cavity or opening; allows tissue biopsy, fluid aspiration, and excision of small tumors. Used for diagnostic and therapeutic purposes
Vesicants
Drugs capable of causing pain, inflammation and blistering of skin, underlying flesh and structures leading to tissue death & necrosis
Most immediate HSRs are immunoglobulin ____________-mediated reaction—an allergic reaction.
E (IgE)
Use of an electric current to destroy tumor cells
Electrosurgery *Basal and squamous cell skin cancers
This approach not only provides the pathologist with the entire tissue specimen for the determination of stage and grade but also decreases the chance of seeding tumor cells (disseminating cancer cells throughout surrounding tissues).
Excisional biopsy
it is possible to erradique 100% of a tumor
FALSE! Eradication of 100% of the tumor is almost impossible; the goal of treatment is eradication of enough of the tumor so that the remaining malignant cells can be destroyed by the body's immune system
When signs and symptoms of HSR occur, the medication should be reduced
FALSE!! When signs and symptoms of HSR occur, the medication should be discontinued immediately and emergency procedures initiated.
weakness and fatigue due to radiation represent deterioration or progression of disease. TRUE OR FALSE?
FALSE. *If systemic symptoms, such as weakness and fatigue, occur, the nurse explains that these symptoms are a result of the treatment and do NOT represent deterioration or progression of the disease.
nurse must administer IV vesicants in peripheral veins
False. •Treatment should neverbe administered in peripheral veins involving the hand or wrist.
Hypercalcemia Clinical Manifestations
Fatigue, weakness, confusion, decreased level of responsiveness, hyporeflexia, nausea, vomiting, constipation, ileus, polyuria (excessive urination), polydipsia (excessive thirst), dehydration, and dysrhythmias
cell cycle RNA and protein synthesis occurs
G1 phase
-premitotic phase - DNA synthesis is complete, mitotic spindle forms
G2 phase
________ therapy includes approaches that correct genetic defects, manipulate genes to induce tumor cell destruction, or assist the body's immune defenses in the hope of preventing or combating disease.
Gene
tumor Grading
Grading: classification of tumor cells
_________________ a major cause of morbidity and mortality in 30% to 50% of the allogeneic transplant population, occurs when the donor lymphocytes initiate an immune response against the recipient's tissues (skin, gastrointestinal tract, liver) during the beginning of engraftmen.The donor cells view the recipient's tissues as foreign or immunologically different from what they recognize as "self" in the donor.
Graft-versus-host disease
__________________ is one bacterium identified as a significant cause of gastric cancer
Helicobacter pylori
What would the nurse assess for bleeding/sepsis which are major complications following HSCT until engraftment occurs?
Hematopoietic Stem Cell Transplantation -Petechiae - Ecchymosis - Fever - Hypotension - Chills - Coffee ground emesis - Abdominal distention
__________ is a potentially life-threatening metabolic abnormality resulting when the calcium released from the bones is more than the kidneys can excrete or the bones can reabsorb.
Hypercalcemia
how is Hyperthermia use with chemotherapy
Hyperthermia is thought to alter cellular membrane permeability when used with chemotherapy, allowing for an increased uptake of the chemotherapeutic agent.
Tumors that do not clearly resemble the tissue of origin in structure or function are described as poorly differentiated or undifferentiated and are assigned grade _____.
IV
Photodynamic therapy
IV administration of a light-sensitizing agent (hematoporphyrin derivative [HPD]) that is taken up by cancer cells, followed by exposure to laser light within 24-48 hours; causes cancer cell death
Cytotoxic Antineoplastic Drugs administration
IV injection or infusion.
nursing management in patient receiving EBRT?
In patients receiving EBRT, the nurse assesses the patient's skin regularly throughout the course of treatment.
In men, the leading causes of cancer are lung, prostate and colorectal. What about women?
In women it's lung followed by breast and colorectal
Topoisomerase I Inhibitors
Induce breaks in the DNA strand by binding to enzyme topoisomerase, preventing cells from dividing *Cell cycle—specific (S phase)
Impaired bone marrow proliferation would place the patient at increased risk for what?
Infection and bleeding
Miscellaneous Agents
Inhibits protein, DNA, and RNA synthesis
The nurse is caring for a client who is being treated with intracavitary brachytherapy. What should the nurse do if the aid assists the client to the bathroom?
Instruct on the importance of maintaining bedrest for this patient
The nurse observes the LPN instruct a family member who is visiting a patient receiving brachytherapy that visits are only allowed for 1 hour. What should the nurse do?
Instruct that visits should be limited to 30 minutes
how to prevent infection as a complication of chemotherapy?
Instruct the patient to avoid exposure to infection by avoiding crowds, anyone with a known infection, and contact with fresh flowers, soil, animals, or animal excrement. Frequent and thorough hand hygiene by the patient and everyone involved in his or her care is necessary to reduce exposure to pathogenic microorganisms.
_____ radiation includes localized implantation or systemic radionuclide administration
Internal
__________ radiation can directly break the strands of the DNA helix, leading to cell death.It can also indirectly damage DNA through the formation of free radicals. If the DNA cannot be repaired, the cell may die immediately or may initiate apoptosis
Ionizing
Sharp, throbbing pain
Ischemia *Kaposi's sarcoma
What is a vesicant?
It is the agent that is deposited into the subcutaneous or surrounding tissues causes the damage and possibly necrosis of tendons, muscles, nerves, and blood vessels.
Patients with acquired immune deficiency syndrome (AIDS) have an increased incidence of what cancer ________________
Kaposi sarcoma
Use of light and energy aimed at an exact tissue location and depth to vaporize cancer cells (also referred to as photocoagulation or photoablation)
Laser surgery
_________ effects (approximately 6 months to years after treatment) of radiation therapy may occur in body tissues that were in the field of radiation. These effects are chronic, usually a result of permanent damage to tissues, loss of elasticity, and changes secondary to a decreased vascular supply.
Late
_____________, a compound similar to folic acid, helps fluorouracil bind with an enzyme inside of cancer cells and enhances the ability of fluorouracil to remain in the intracellular environment.
Leucovorin
patient taking Methotrexate is exexperiencing significant toxicity, including severe bone marrow suppression, mucositis, diarrhea and liver, and lung and kidney damage, can occur. What drug would the nurse administer to help with these symptoms?
Leucovorin helps to prevent or lessen these toxicities.
right atrial silastic catheters
Long-term silastic catheters, inserted into the right atrium via a jugular vein * to prevent Extravasation of vesicants
Use of magnetic fields and radiofrequency signals to create sectioned images of various body structures
Magnetic resonance imaging (MRI)
Use of x-ray images of the breast
Mammography
Leukemia
May involve various cell lines produced in the bone marrow *
Colorectal
Men and women, ages 50+
____________ is a cytoprotectant agent that binds with the toxic metabolites of cyclophosphamide or ifosfamide in the kidneys to prevent hemorrhagic cystitis.
Mesna (Mesnex)
duplicated chromosomes separate and cell division occurs in what phase?
Mitosis
Radioimmunoconjugates
Monoclonal antibodies are labeled with a radioisotope and injected IV into the patient; the antibodies that aggregate at the tumor site are visualized with scanners
Cytotoxic Antineoplastic Drugs
Most of these drugs kill malignant cells by interfering with cell replication, with the supply and use of nutrients (e.g., amino acids, purines, pyrimidines), or with the genetic materials in the cell nucleus (DNA or RNA).
_______, a common side effect of radiation and some types of chemotherapy, refers to an inflammatory process involving the mucous membranes of the oral cavity and the gastrointestinal tract.
Mucositis
Most common form of cancer of the bone
Osteosarcoma
___________ (abnormally high concentrations) of host suppressor T lymphocytes induced through the release of cytokines by malignant cells is thought to down-regulate the immune response, thus permitting uncontrolled cell growth
Overexpression
Some cancer cells have been found to have altered cell membranes that interfere with APC binding and presentation to T lymphocytes. Tumors can also express molecules that induce T-lymphocyte anergy or tolerance such as ___________.
PD-1 ligand *These molecules bind to PD-1 proteins on T lymphocytes and either block the killing of the tumor or induce cell death in the lymphocyte.
______________, an IV-administered synthetic form of human keratinocyte growth factor, is beneficial in the prevention of stomatitis in patients with hematologic malignancies who are preparing for HSCT
Palifermin (Kepivance)
___________ radiation therapy is used to relieve the symptoms of locally advanced or metastatic disease, especially when the cancer has spread to the brain, bone, or soft tissue, or to treat oncologic emergencies, such as superior vena cava syndrome, bronchial airway obstruction, or spinal cord compression.
Palliative
What are some common signs of thrombocytopenia?
Petechiae and ecchymosis
Tumor Lysis Syndrome (TLS)
Potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small cell lung cancer. *leads to rapidly induced electrolyte imbalances
Superior Vena Cava Syndrome (SVCS)
Progressive occlusion of the superior vena cava that leads to venous distention of upper extremities and head * If untreated, SVCS may lead to cerebral anoxia laryngeal edema, bronchial obstruction, and death.
_____ therapy, a form of external radiation, permits treatment of deep tumors in close proximity to critical structures, such as the heart or major blood vessels.
Proton
___________ therapy is another approach to EBRT. It utilizes high linear energy transfer (LET) in the form of charged protons generated by a large magnetic unit called a cyclotron.
Proton
Non-dividing cells capable of future proliferation are the least sensitive to antineoplastic medications and consequently are potentially dangerous. However, the non-dividing cells must be destroyed to eradicate the disease. How are these cell destroyed?
Repeated cycles of chemotherapy or sequencing of multiple chemotherapeutic agents is used to achieve more tumor cell destruction by destroying the non-dividing tumor cells as they begin active cell division
What is another disease process that methotrexate is used for?
Rheumatoid Arthritis
- These catherer is inserted into the subclavian vein and advanced until its tip lies in the superior vena cava just above the right atrium. - The proximal end is then tunneled from the entry site through the subcutaneous tissue of the chest wall and brought out through an exit site on the chest. * The Dacron cuff anchors the catheter in place and serves as a barrier to infection.
Right atrial catheter
Dacron cuff anchors
Right atrial catheter. * anchors the catheter in place and serves as a barrier to infection.
cell cycle-specific agents destroy cells that are actively reproducing by means of the cell cycle; most affect cells in the _____ phase by interfering with DNA and RNA synthesis.
S
DNA synthesis occurs during
S phase of interphase
At which level of prevention are screenings done?
Secondary
____________ prevention involves screening and early detection activities that seek to identify precancerous lesions and early-stage cancer in individuals who lack signs and symptoms of cancer.
Secondary
______________, also known as sentinel lymph node mapping, is a minimally invasive surgical approach that in many instances has replaced more invasive lymph node dissections (lymphadenectomy) and the associated complications such as lymphedema and delayed healing.
Sentinel lymph node biopsy (SLNB) *has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer
If the body fails to recognize the TAAs on cancer cells or the function of the APCs is impaired, the immune response is not stimulated. how?
Some cancer cells have been found to have altered cell membranes that interfere with APC binding and presentation to T lymphocytes.
So then, why do we stage and grade tumors?
Staging of a tumor is done to communicate the size of the tumor, if lymph nodes are involved, and if there is metastasis
_______________ is another form of EBRT that uses higher doses of radiation to penetrate very deeply into the body to control deep-seated tumors that cannot be treated by other approaches such as surgery.
Stereotactic body radiotherapy (SBRT)
__________, a form of mucositis, is an inflammatory process of the mouth, including the mucosa and tissues surrounding the teeth.
Stomatitis
Biologic Response Modifiers
Substances produced by normal cells that block tumor growth or stimulate the immune system to fight cancer.
Tumor-associated antigens (TAAs) are found on the membranes of many cancer cells. TAAs are processed by antigen-presenting cells (APCs) and are presented to _____________ that recognize the antigen-bearing cells as foreign.
T lymphocytes
TNM Classification System T= N= M=
T= The extent of the primary tumor N= The absence or presence and extent of regional lymph node metastasis M= The absence or presence of distant metastasis
Although patients may or may not react to the first infusion of a chemotherapy agent, repeated exposure increases the likelihood of a hypersensitivity reactions (HSRs)
TRUE
If extravasation is suspected, the medication administration is stopped immediately.
TRUE
Improved screening, diagnosis, and treatment approaches have led to an estimated 14.5 million cancer survivors in the United States . __________ prevention efforts focus on monitoring for and preventing recurrence of the primary cancer as well as screening for the development of second malignancies in cancer survivors.
Tertiary
Before administrating this medication, what factors should the nurse assess?
The nurse should assess the time of the surgery (the drug should be given 30-60 minutes prior), the patient's understanding of the need to receive the antibiotic, the patient's kidney function (by reviewing blood urea nitrogen and creatinine), and the patency of the IV line (the drug could cause thrombophlebitis).
Tim Fox, a 42-year-old man with a history of mild renal insufficiency, has received a diagnosis of Hodgkin's disease. He has completed a course of radiation therapy and is preparing to begin adjuvant chemotherapy, with a drug regimen that includes doxorubicin, bleomycin, vinblastine, and dacarbazine. Mr. Fox asks the nurse why he has to take so many different chemotherapeutic drugs. How should the nurse respond?
The nurse should explain that combination drug therapy is used in cancer treatment because it is more effective, less toxic, and less likely to cause drug resistance.
Why did the nurse ask the patient about a penicillin allergy with the administration of a cephalosporin?
There is a potential for cross-reactivity with patients that have a severe penicillin allergy due to the common beta-lactam ring.
Continuous infusion of vesicants that takes longer than 1 hour or are given frequently are given only via a central line, such as a right atrial silastic catheter, implanted venous access device, or PICC. Why?
These long-term venous access devices promote safety during medication administration and reduce problems with repeated access to the circulatory system
those body tissues that undergo frequent cell division are most sensitive to radiation therapy.
These tissues include bone marrow, lymphatic tissue, epithelium of the gastrointestinal tract, hair follicles, and gonads.
Positron emission tomography (PET)
Through the use of a tracer, provides black-and-white or color-coded images of the biologic activity of a particular area, rather than its structure. Used in detection of cancer or its response to treatment
a condition that occurs when a large number of cancer cells die within a short period, releasing their contents in to the blood.
Tumor lysis syndrome (TLS)
When tumors do not possess _________that label them as foreign, the immune response is not alerted. This allows the tumor to grow too large to be managed by normal immune mechanisms.
Tumor-associated antigens (TAAs; also called tumor cell antigens)
These molecules bind to PD-1 proteins on T lymphocytes and either block the killing of the tumor or induce cell death in the lymphocyte.
Tumors can express molecules that induce T-lymphocyte anergy or tolerance such as PD-1 ligand
High-frequency sound waves echoing off body tissues are converted electronically into images; used to assess tissues deep within the body
Ultrasonography (ultrasound)
when placing a patient that wanted to go to the bathroom (not allowed) back to bed the radioactive device falls to the floor. What should the nurse do?
Use long forceps to pick up the device and place it in a lead container *keep a lead container in the room in case a radioactive device dislodges
Fluoroscopy
Use of x-rays that identify contrasts in body tissue densities; may involve the use of contrast agents
Radiofrequency ablation (RFA)
Uses localized application of thermal energy that destroys cancer cells through heat: temperatures exceed 50°C (122°F)
Warburg effect
When cancer cells utilize an increase amount of glucose, even in the presence of oxygen
Nonspecific Biologic Response Modifiers
When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells.
Mammography
Women should undergo regular screening mammography starting at age 40 years
cachexia
a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS
Carcinoma
a malignant tumor that occurs in epithelial tissue
apoptosis:
a normal cell mechanism of programmed cell death
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
Radioactive iodine (I-131)
a widely used form of systemic brachytherapy that is the primary treatment for thyroid cancer
neutropenia
abnormally low absolute neutrophil count
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?
administering metoclopramide and dexamethasone as ordered
advantage of proton therapy
advantage of proton therapy is that it is capable of delivering its high-energy dose to a deep-seated tumor, with decreased doses of radiation to the tissues in front of the tumor while virtually no energy exits through the patient's healthy tissue behind the tumor
Hemorrhagic cystitis is a bladder toxicity that can result from certain chemo drugs and can lead to life-threatening hemorrhage. So nurses need to protect the bladder by
aggressive IV hydration, frequent avoiding, and diuresis
E (IgE)-mediated reaction
allergic reaction
IgE function
allergic reactions
One medication, ______________, is occasionally used in patients with head and neck cancers to reduce acute and chronic xerostomia while preserving antitumor efficacy of the necessary radiation doses
amifostine (Ethyol)
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
Tumor marker identification
analysis of substances fund in body—tissues, blood, or other body fluids that are made by the tumor or by the body in response to the tumor
The degree of _________ (a pattern of growth in which cells lack normal characteristics and differ in shape and organization with respect to their cells of origin) is associated with increased malignant potential.
anaplasia
Among the many causes of _____________ in patients with cancer are alterations in taste, manifested by increased salty, sour, and metallic taste sensations, and altered responses to sweet and bitter flavors.
anorexia
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?
anticipatory grieving
TAAs are processed by
antigen-presenting cells (APCs)
Intracavitary radioisotopes
are used to treat gynecologic cancers.
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?
autologous
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?
avoiding using soap on the irradiated areas
Resistance to hyperthermia may develop during the treatment. why?
because cells adapt to repeated thermal insult.
patient with mucositis should brush the teeth after meals and at bedtime with a soft toothbrush and floss once daily. Stop brushing and flossing if the platelet count drops below 20,000/mm3. WHY?
because gingival bleeding is likely.
Hyperthermia and radiation therapy are thought to work well together. Why?
because hypoxic tumor cells and cells in the S phase of the cell cycle are more sensitive to heat than radiation, and the addition of heat damages tumor cells so that they cannot repair themselves after radiation therapy.
Stomatitis is commonly associated with some chemotherapy agents. Why?
because of the rapid turnover of epithelium that lines the oral cavity.
Body tissues most affected by radiation are those that normally proliferate rapidly, such as the skin, the epithelial lining of the gastrointestinal tract, and the bone marrow. Why is this?
because radiation targets ALL rapidly growing cells
Sarcoma
begin in the bones and in the soft (also called connective) tissues
Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?
blood studies
Thrombocytopenia often results from _________________after certain types of chemotherapy and radiation therapy and with tumor infiltration of the bone marrow.
bone marrow depression
how to prevent dislodgment of intracavity low-dose radiation?
by maintaining the client on bed rest, and a private room, provide low residue diet it's, give antidiarrheal agents to prevent bowel movements, log roll to prevent dislodgment of device and insert a Foley
Antineoplastic hormone inhibitor drugs used in the treatment of cancer... A. are highly cytotoxic to both cancer cells and normal cells B. target specific antigens or vital processes of cancer cells C. slow the growth of some cancer cells d. protect normal cells from cytotoxic drugs
c. Hormone inhibitor drugs slow the growth of cancer cells that are stimulated by hormones. They are not cytotoxic. They cause less damage to normal cells than cytotoxic chemotherapy; however, the drugs may still cause serious adverse effects. They do not target specific antigens or vital processes of cancer cells. Biologic drugs do not have protective effects on normal cells.
What's the second leading cause of death?
cancer
a group of disorders characterized by abnormal cell proliferation, in which cells ignore growth-regulating signals in the surrounding environment
cancer
targeted therapies
cancer treatments that seek to minimize the negative effects on healthy tissues by disrupting specific cancer cell functions (such as malignant transformation), metabolism, communication pathways, processes for growth and metastasis, and genetic coding
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?
carcinoma in situ, nor abnormal regional lymph nodes, no evidence of distant metastasis
how to prevent bleeding as a complication of chemotherapy?
caused by thrombocytopenia and may occur spontaneously or with minor trauma. Precautions should be instituted if the platelet count drops to 50,000/mm3 or below.
Chemotherapeutic agents may be classified by their mechanism of action in relation to the cell cycle. Agents that exert their maximal effect during specific phases of the cell cycle are termed ______________ agents.
cell cycle-specific
carcinogens
chemicals, physical factors, and other agents that cause cancer
Each time a tumor is exposed to ___________, a percentage of the tumor cells (20% to 99%, depending on dosage and agent) are destroyed. Repeated doses of chemotherapy are necessary over a prolonged period to achieve regression of the tumor.
chemotherapy
the use of medications to kill tumor cells by interfering with cellular functions and reproduction
chemotherapy
A cancer client makes the following statement to the nurse: "I guess I will tell my doctor 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
The experience of ________________________ (CINV) may affect quality of life, psychological status, nutrition, fluid and electrolyte status, functional ability, compliance with treatment, and utilization of health care resources
chemotherapy-induced nausea and vomiting
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?
closely observe the client's skin for petechiae and bruising
allogeneic transplantation
comes from the donor other than the patient
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?
control
Anorexia may occur because patients develop early satiety after eating only a small amount of food. This sense of fullness occurs secondary to:
decrease in digestive enzymes, abnormalities in the metabolism of glucose and triglycerides, and prolonged stimulation of gastric volume receptors, which convey the feeling of being full
thrombocytopenia
decrease in the number of circulating platelets * associated with the potential for bleeding
petechiae and ecchymoses, are early indicators of ______________________. Early detection promotes early intervention.
decreasing platelet levels *Thrombocytopenia
pancytopenia
deficiency of all types of blood cells
neutropenia.
deficiency of neutrophils
radiation ______ occur along a continuum ranging from erythema and dry desquamation (flaking of skin) to moist or wet desquamation (dermis exposed, skin oozing serous fluid) to, potentially, ulceration.
dermatitis
-lysis
destruction
Tumor Staging
determines size of tumor, existence of metastasis TNM T: extent of primary tumor N: lymph node involvement M: extent of metastasis
Prenatal exposure to _________________ (a synthetic form of the female hormone estrogen) has long been recognized as a risk factor for clear cell adenocarcinoma of the lower genital tract.
diethylstilbestrol
xerostomia
dry mouth
The nurse is evaluating the client's risk for cancer and recommends changes when the client states she
eats red meat such as steaks or hamburgers every day
You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes?
encourage cheese and sandwiches
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?
encourage fluid intake to dilute the urine
A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:
encourage fluid intake, if possible, to dilute the urine
Cancers of the breast, prostate, and uterus are thought to depend on ____________ hormonal levels for growth.
endogenous
Tumor growth may be promoted by disturbances in hormonal balance, either by the body's own (_____________) hormone production or by administration of _________ hormones.
endogenous exogenous
A cluster of symptoms referred to as ____________ syndrome may occur during the neutrophil recovery phase in both allogeneic and autologous transplants. Clinical features of this syndrome vary widely but may include noninfectious fever associated with skin rash, weight gain, diarrhea, and pulmonary infiltrates, with improvement noted after the initiation of corticosteroid therapy rather than antibiotic therapy
engraftment
extravasation:
escape of blood from the blood vessel into the tissue
Women who take _________ after menopause appear to have an increased risk of ovarian cancer.
estrogen
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?
excisional biopsy
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient?
explain to the patient that she will continue to emit radiation while the implant is in place
hysical factors associated with carcinogenesis include:
exposure to sunlight, radiation, chronic irritation or inflammation, tobacco carcinogens, industrial chemicals and asbestos.
Intravenously given chemotherapy agents are additionally classified by their potential to damage tissue if they inadvertently leak from a vein into surrounding tissue, termed __________
extravasation
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?
extravasation
Is the following statement True or False? Patients receiving low-dose radiation (brachytherapy) can have their significant others stay with them in the hospital
false
someone with a tumor shouldn't worry about getting cancer
false! tumors can start growing and become malignant
radiation affect all parts of body
false, radiation therapy is localized treatment, and only the tissues that are within the treatment field are affected.
Systemic side effects are commonly experienced by patients receiving radiation therapy. These include:
fatigue, malaise, and anorexia
implanted venous access devices
for long term use of vesicants
In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called ___________.
fractions
colony-stimulating factors (granulocyte colony-stimulating factor [G-CSF] and granulocyte-macrophage colony-stimulating factor [GM-CSF])
given after chemotherapy to stimulate the bone marrow to produce WBCs, especially neutrophils, at an accelerated rate, thus decreasing the duration of neutropenia.
These tumors tend to be more aggressive, less responsive to treatment, and associated with a poorer prognosis as compared to well-differentiated, grade I tumors.
grade IV
_____________ is the pathologic classification of tumor cells. Grading systems seek to define the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and histologic characteristics of the tissue of origin (differentiation).
grading
identification of the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and structural characteristics of the tissue of origin
grading
The nurse is working with a client who has had an allohematopoietic 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
graft-versus-host disease
An advantage of AlloHSCT is that the transplanted cells should not be immunologically tolerant of a patient's malignancy and should cause a lethal _______________ in which the donor cells recognize the malignant cells and act to eliminate them.
graft-versus-tumor effect
angiogenesis
growth of new blood vessels that allow cancer cells to grow
alopecia
hair loss
primary prevention of cancer
health promotion and risk reduction strategies
The physician recommends that parents have their daughter vaccinated with HPV vaccine. What is this vaccine for?
help prevent cervical cancer
During the first 30 days after the conditioning regimen, AlloHSCT patients are at risk for developing ________________________ (HSOS) (previously referred to as veno-oclusive disease) related to chemotherapy-induced inflammation of the sinusoidal epithelium.
hepatic sinusoidal obstructive syndrome
Radiation sensitivity is enhanced in tumors that are smaller in size and that contain cells that are rapidly dividing (_______________) and poorly differentiated (no longer resembling the tissue of origin).
highly proliferative
Erythropoietin (EPO)
hormone secreted by the kidney to stimulate the production of red blood cells by bone marrow
When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply.
hyperkalemia, hyperuricemia, heyperphosphatemia
Syngeneic trasplant
identical twin
Indwelling or subcutaneous venous access devices require consistent nursing care. Complications include:
infection and thrombosis
mucositis
inflammation of the lining of the mouth, throat, and gastrointestinal tract often associated with cancer therapies
stomatitis
inflammation of the oral tissues, often associated with some chemotherapeutic agents and radiation therapy to the head and neck region
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
inspecting the skin for petechiae once every shift
Fine-needle aspiration (FNA) biopsy
involves aspirating cells rather than intact tissue through a needle that is guided into a suspected diseased area. This type of specimen can only be analyzed by cytological examination (viewing only cells, not tissue).
Intraluminal HDR brachytherapy
involves the insertion of catheters or hollow tubes into the lumens of organs so that the radioisotope can be delivered as close to the tumor bed as possible.
Systemic radiotherapy
involves the intravenous (IV) administration of a therapeutic radioactive isotope targeted to a specific tumor.
The primary advantage of HDR brachytherapy ?
is that treatment time is shorter, there is reduced exposure to personnel, and the procedure can be performed on an outpatient basis over several days.
What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?
it lowers serum and uric acid levels
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
extravasation
leakage of intravenous medication from the veins into the subcutaneous tissues
In certain regimens, additional medications are given with chemotherapy agents to enhance activity or protect normal cells from injury. For example, ____________ is often given with fluorouracil (5-FU) to treat colorectal cancer.
leucovorin (Wellcovorin)
radiation therapy is _________treatment, and only the tissues that are within the treatment field are affected.
localized
Anorexia
loss of appetite
nadir
lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow
leading causes of cancer death in women?
lung, breast, and colorectal cancer in women.
leading causes of cancer death in men?
lung, prostate, and colorectal cancer
The most common malignancies treated with AuHSCT include ____________ and _____________
lymphoma and multiple myeloma
having cells or processes that are characteristic of cancer
malignant
Lymphoma
malignant tumor of lymph nodes and lymph tissue * Non-Hodgkin lymphoma * Hodgkin lymphoma
spread of cancer cells from the primary tumor to distant sites
metastasis
The advantages of minimally invasive approaches:
minimization of surgical trauma, decreased blood loss, decreased incidence of wound infection and other complications associated with surgery, decreased surgical time and requirement for anesthesia, decreased postoperative pain and limited mobility, and shorter periods of recovery
as an effect chemotherapy, the entire gastrointestinal tract is susceptible to _________ (inflammation of the mouth, throat, and gastrointestinal tract) with diarrhea.
mucositis
Suppressor T lymphocytes normally assist in regulating lymphocyte production and diminishing immune responses (i.e., antibody production) when they are no longer required. Low levels of antibodies and high levels of suppressor cells have been found in patients with multiple ________, which is a cancer associated with hypogammaglobulinemia (low amounts of serum antibodies).
myeloma
Many chemotherapy agents cause some degree of _________________(depression of bone marrow function), resulting in decreased WBCs (leukopenia), granulocytes (neutropenia), red blood cells (RBCs) (anemia), and platelets (thrombocytopenia) and increased risk of infection and bleeding.
myelosuppression
The ______ is the lowest ANC following chemotherapy, targeted therapy, or radiation therapy that suppresses bone marrow function.
nadir
Several mechanisms are responsible for the occurrence of __________ and _________, including activation of multiple receptors found in the vomiting center of the medulla, the chemoreceptor trigger zone, the gastrointestinal tract, the pharynx, and the cerebral cortex
nausea and vomiting
most common side effects of chemotherapy are _______ and ________, which may persist for 24 to 48 hours
nausea and vomiting *delayed nausea and vomiting may occur up to 1 week after administration
Cancerous cells, described as malignant neoplasms, demonstrate uncontrolled cell growth that follows no physiologic demand ________
neoplasia
colony-stimulating factors (granulocyte colony-stimulating factor [G-CSF] and granulocyte-macrophage colony-stimulating factor [GM-CSF])—can be given after chemotherapy to stimulate the bone marrow to produce WBCs, especially neutrophils, at an accelerated rate, thus decreasing the duration of ________________
neutropenia.
A client with ovarian cancer is ordered hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with
normal cellular processes during the S phase of the cell cycle
Early Signs of Thrombocytopenia
observe keenly for petechiae and ecchymoses, which are early indicators of decreasing platelet levels. Early detection promotes early intervention.
field or study of cancer
oncology
Prostate HDR therapy
one form of interstitial brachytherapy, in which radioactive strands or wires are placed, while the patient is under anesthesia, into hollow catheters that have been inserted in the perineum close to the prostate gland
what should the nurse do is extravasation is suspected?
othe medication administration is stopped immediately
______ surgery is performed in an attempt to relieve complications of surgery
palliative
Majority of chemotherapy drugs causes myelosuppression or depression of bone marrow functioning. This results in ____________and increases the risk for infection, bleeding and fatigue
pancytopenia
anaplasia
pattern of growth in which cells lack normal characteristics and differ in shape and organization with respect to their cells of origin; usually, anaplastic cells are malignant
how to prevent Graft-versus-host disease
prevent GVHD, patients receive immunosuppressant drugs, such as cyclosporine (Sandimmune), methotrexate, tacrolimus (Prograf), or mycophenolate mofetil (MMF).
an example of ___________ prevention is the use of immunization to reduce the risk of cancer through prevention of infections associated with cancer. The HPV vaccine is recommended to prevent cervical and head and neck cancers.
primary
external radiation
process of administering radiation to the patient via a radiation machine located outside the body * external-beam radiation therapy (EBRT) *Stereotactic body radiotherapy (SBRT) *Proton therapy
staging
process of determining the extent of disease, including tumor size and spread or metastasis to distant sites
carcinogenesis
process of transforming normal cells into malignant cells
apoptosis
programmed cell death
Actively ___________ cells within a tumor are the most sensitive to chemotherapy (the ratio of dividing cells to resting cells is referred to as the growth fraction).
proliferating
type of surgery being done when lesions that are removed are likely to develop into cancer is called ____________
prophylactic
the use of ionizing radiation to kill malignant cells
radiation therapy
Slower-growing tissues and tissues at rest (e.g., muscle, cartilage, nervous system, and connective tissues) are relatively ____________ (less sensitive to the effects of radiation).
radioresistant
A _____________ tumor is one that can be destroyed by a dose of radiation that still allows for cell repair and regeneration in the surrounding normal tissue.
radiosensitive
Nitrosoureas
similar to alkylating agents * cross the blood-brain barrier
Extravasation of a vesicant could result in tissue necrosis. How can the nurse prevent these?
so never use the hand or wrist and prevent extravasation by confirming patency of the intravenous device
Erythropoietin (EPO) drug
stimulates RBC production, thus decreasing the symptoms of treatment-induced chronic anemia and reducing the need for blood transfusions.
Anorexia, nausea, vomiting, and diarrhea may occur if the _________ or _________ is in the radiation field.
stomach or colon *Depending on the targeted region, any portion of the gastrointestinal mucosa may be involved, causing mucositis
A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?
stomatitis
Risk factors and comorbidities associated with __________ include poor oral hygiene, general debilitation, existing dental disease, prior irradiation to the head and neck region, impaired salivary gland function, the use of other medications that dry mucous membranes,myelosuppression (bone marrow depression), advanced age, tobacco use, previous stomatoxic chemotherapy, diminished renal function, and impaired nutritional status
stomatitis
inflammation of the mouth
stomatitis
vesicant
substance that can cause inflammation, damage, and necrosis with extravasation from blood vessels and contact with tissues
Cytokines
substances produced primarily by cells of the immune system to enhance production and functioning of components of the immune system
stem cell infusion adverse efects
such as fever, chills, shortness of breath, chest pain, cutaneous reactions, nausea, vomiting, hypotension or hypertension, tachycardia, anxiety, and taste changes
myelosuppression
suppression of the blood cell-producing function of the bone marrow
In humans, transformed cells arise on a regular basis, but are recognized by _________ cells of the immune system that destroy them before cell growth becomes uncontrolled (immune surveillance).
surveillance
graft-versus-tumor effect:
the donor immune cell response against the malignancy * a desirable response
The dosage of chemotherapeutic agents is based primarily on:
the patient's total body surface area, weight, previous exposure and response to chemotherapy or radiation therapy, and function of major organ systems.
for those patients who are thrombocytopenic the nurse should avoid:
the rectal route for medication administration as well as IM injections
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 have synergistic effect and act on the cancer cells with different mechanisms
brachytherapy
the use of radioactive materials in contact with or implanted into the tissues to be treateddelivery of radiation therapy through internal implants placed inside or adjacent to the tumor
A client with metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy?
to prevent metastasis
cryotherapy
topical application of oral ice during infusions
absolute neutrophil count (ANC)
total number of WBC's x percentage of neutrophils
The nurse is caring for a patient who has evidence of wet desquamation. The patient wants to open the blisters. What should the nurse do?
treat wet desquamation by leaving blisters in tact and notifying primary care provider, avoid frequent washing of area because of increased irritation, obtain an order for a cream or ointment (such as Aquaphor or silver Silvadene) and use a non-adhesive pad over the area
75% of all cancers in the US are related to environmental and lifestyle factors
true
Fatigue is one of the most frequent and distressing symptoms experienced by patients receiving cancer therapy. Patients report that fatigue persists and interferes with activities of daily living for months to years after the completion of treatment
true
Hormonal changes related to the female reproductive cycle are also associated with cancer incidence.
true
If the radiation is delivered when most tumor cells are cycling through the cell cycle, the number of cancer cells destroyed (cell kill) is maximal.
true
Increased numbers of pregnancies are associated with a decreased incidence of breast, endometrial, and ovarian cancers.
true
Malignant neoplasms invade other tissues (metastasis) and branch off while benign tumors do not metastasize
true
Methotrexate contributes to folic acid deficiency and results in cell death
true
The use of injectable dyes and nuclear medicine imaging can help identify the sentinel lymph node or the initial lymph node to which the primary tumor and surrounding tissue drain.
true
There is evidence that passive smoke may be linked with childhood leukemia and cancers of the larynx, pharynx, brain, bladder, rectum, stomach, and breast
true
Through the process of immune surveillance, an intact immune system usually has the ability to recognize and combat cancer cells through multiple, interacting cells and actions of the innate, humoral, and cellular components of the immune system
true
Transplant recipients who receive immunosuppressive therapy to prevent rejection of the transplanted organ have an increased incidence of cancer
true
Treatment approaches are not initiated until the diagnosis of cancer has been confirmed and staging and grading have been completed.
true
Tumor markers (for example CEA, CA 125) are monitored to help determine the effectiveness of chemotherapy
true
Until engraftment of the new marrow occurs, the patient is at high risk for death from sepsis and bleeding.
true
Vesicant chemotherapy should never be given in peripheral veins involving the hand or wrist. Peripheral administration is permitted for short-duration infusions only, and placement of the venipuncture site should be on the forearm area using a soft, plastic catheter.
true
When the immune system fails to identify and stop the growth of transformed cells, a tumor can develop and progress.
true
Grade I tumor
tumor cells well differentiated
radiosensitive tumor
tumor in which radiation can cause the death of cells without serious damage to surrounding tissue
A ___________ is a biomarker found in blood, urine, or body tissues that can be elevated by the presence of one or more types of cancer. There are many different tumor markers, each indicative of a particular disease process, and they are used in oncology to help detect the presence of cancer
tumor marker
Myeloma
tumor of the bone marrow
The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?
tumor pressure against normal tissues
staging determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis. Several systems exist for classifying the anatomic extent of disease. The _______________ is one system used to describe many solid tumors
tumor, nodes, and metastasis (TNM) system
neoplasia
uncontrolled cell growth that follows no physiologic demand * cancer
tumor-specific antigen
unique protein on cell surface of tumors; measurement helps to track the extent of cancer as malignant cells mature and become less differentiated
Your client is receiving radiation therapy. The client asks you about oral hygiene. What advice regarding oral hygiene should you offer?
use a soft toothbrush and avoid an electronic toothbrush
Palifermin (Kepivance)
use for stomatitis * promotes epithelial cell repair and accelerated replacement of cells in the mouth and gastrointestinal tract.
Interstitial HDR implants
used in treating such malignancies as prostate, pancreatic, or breast cancer, may be temporary or permanent, depending on the site and radioisotope used.
Nuclear medicine imaging
uses IV injection or ingestion of radioisotope substances followed by imaging of tissues that have concentrated the radioisotopes
precision medicine
using advances in research, technology, and policies to develop individualized plans of care to prevent and treat diseas
autologous transplant
using some of the patient's own bone marrow that was harvested before treatment began
Brachytherapy safety precautions
• private room •post appropriate notices about radiation safety precautions •staff members meter badges •pregnant staff members not assigned to the patient's care •prohibit visits by children or pregnant visitors •visits 30 minutes a day • 6 foot distance from the radiation source
What primary prevention measures should the nurses educate patients on to reduce the risks of disease?
•Avoid known carcinogens •Increase physical activity •Smoking cessation •Decrease caloric and alcoholic intake
How do the treatment options differ? - cure - control - palliation
•Cure: complete eradication of the malignancy •Control: prolonged survival and containment of cancer cell growth •Palliation: relief of symptoms associated with the malignancy and improvement of quality of life
Give me some examples of dietary substances that are known to be carcinogenic.
•Fats, •alcohol, •salt cured or smoked meats, •nitrate and nitrite containing foods, •red and processed meats. •Alcohol intake
Port-A-Cath's
•For frequent or prolonged administration vesicants
What are the early indicators of decreasing platelet levels?
•Petechiae •Ecchymosis
What are the systemic effects associated with radiation therapy?
•fatigue, •malaise, •anorexia. •loss of elasticity, •permanent damage to tissues, •changes secondary to a decreased vascular supply. •fibrosis, •atrophy •ulceration •necrosis.
