Adult 1 - Oncology - Unit 2 - Ch. 12

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant?

Monitor the client closely to prevent infection Until transplanted stem cells begin to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection

What type of biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney?

Needle biopsy

TNM Classification System "N0" represents what?

No regional lymph node metastasis

TNM Classification System "T" represents what?

The extent of the primary tumor

TNM Classification System "M1" represents what?

There is distant metastasis

Flossing may increase the risk of bleeding in a client with a platelet count less than ...

40,000/mm3

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?

Adjuvant therapy is likely T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

Administering metoclopramide and dexamethasone as ordered The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy.

The American Cancer Society recommendations for women: they may choose to stop having Pap tests for cervical cancer screening under what circumstances?

Age 66+ have had normal Pap tests for 10 years had a total hysterectomy

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?

Allogeneic If the source of donor cells is from a donor other than the patient, it is termed allogeneic. Autologous donor cells come from the patient. Syngeneic donor cells are from an identical twin. Homogenic is not a type of stem cell transplant.

A serum sodium concentration lower than 120 mEq/L (115 mmol/L) is associated with

Anorexia, weight gain, and myalgia

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?

Antimetabolite

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?

Autologous vaccines are made from the client's own cancer cells, which are obtained during diagnostic biopsy or surgery

A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan?

Avoiding using soap on the irradiated areas Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied

When does bone marrow suppression become noticable after floxuridine administration?

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

Which type of radiation aims to protect healthy tissue during the treatment?

Brachytherapy In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body through the use of an implant. With this type of therapy, the farther the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy

Common cancers in women include

Breast, lung, and colon

TNM Classification System "Tis " represents what?

Carcinoma in situ

A client has just received stem cell transplantation as treatment for leukemia. For how long should the client be monitored after the procedure?

Closely monitor the client for at least 3 months After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common

The drug interleukin-2 is an example of which type of biologic response modifier?

Cytokine Other cytokines include interferon alfa and filgrastim

TNM Classification System "Mx" represents what?

Distant metastasis cannot be assessed

A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to:

Increase her intake of calcium-rich foods

TNM Classification System "N1, N2, N3" represents what?

Increasing involvement of regional lymph nodes

dietary recommendations for reducing the risk of cancer

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

What type of biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts? In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues.

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 When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source

The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important?

Flush the toilet several times after every use Iodine 131 is a systemic internal radiation that is excreted through body fluids, especially urine. Flushing the toilet several times after each use will avoid the exposure of others to radioactive exposure.

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?

Ham and bacon 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. Nitrates are added to cured meats, such as ham and bacon

What type of biopsy is performed if the tumor mass is too large to be removed? In this case, a wedge of tissue from the tumor is removed for analysis.

Incisional biopsy

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 Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding.

The client undergoing what type of chemotherapy may expose his family to radiation?

Internal radiation, not external radiation, poses a risk to the client's family

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse?

It lowers serum and uric acid levels The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurrence can be reduced with allopurinol's action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure

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

The nurse is assessing the diet of a female client. To decrease the risk of cancer in general, the nurse instructs the client to

Limit alcohol ingestion to one drink per day. Alcohol increases the risks of certain cancers and should be limited to no more than one drink per day for women

A patient is taking vincristine, a plant alkaloid for the treatment of cancer. What system should the nurse be sure to assess for symptoms of toxicity?

Nervous system With repeated doses, the taxanes and plant alkaloids, especially vincristine, can cause cumulative peripheral nervous system damage with sensory alterations in the feet and hands

TNM Classification System "M0" represents what?

No distant metastasis

TNM Classification System "T0" represents what?

No evidence of primary tumor

TNM Classification System "Tx" represents what?

Primary tumor cannot be assessed

What type of surgery involves removing nonvital tissues or organs that are likely to develop cancer?

Prophylactic surgery

TNM Classification System "Nx" represents what?

Regional lymph nodes cannot be assessed

A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis?

Risk for infection related to inadequate defenses Physiological needs, such as risk for infection, take priority over the client's other needs

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?

Shorten the period of neutropenia Neutropenia occurs when you have too few neutrophils, a type of white blood cells Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation

_____________is an inflammation of the oral cavity. The client should be encouraged to brush the teeth with a soft toothbrush after meals,

Stomatitis

TNM Classification System "T 1-4 " represents what?

T1, T2, T3, T4 Increasing size or local extent of the primary tumor

TNM Classification System "N" represents what?

The absence or presence and extent of regional lymph node metastasis

TNM Classification System "M" represents what?

The absence or presence of distant metastasis

The client should be encouraged to take what actions if they develop a mild oral yeast infection following chemotherapy?

The client 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.

What is the best way for the nurse to assess the nutritional status of a patient with cancer?

Weigh the patient daily Common nutritional problems in clients with cancer include anorexia, malabsorption, and the extreme weight loss of cancer-related anorexia-cachexia syndrome (CACS). Because malnutrition may occur due to problems with absorption of nutrients or increased metabolic demands, weighing the client regularly is the best way to monitor nutritional status

Clients who undergo bone marrow transplantation typically remain hospitalized for how long?

20 to 25 days.

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic?

Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions.

The nurse should teach the patient who is being radiated about protecting his skin and oral mucosa. An important teaching point would be to tell the patient to

Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth The patient should cleanse himself with a mild soap using his fingertips rather than a wash cloth. All the other choices will irritate the skin and fail to protect it from additional injury

While administering cisplatin to a client, the nurse assesses swelling at the insertion site. What is the nurse's first action?

Discontinue the intravenous medication If extravasation of a chemotherapeutic medication is suspected, the nurse immediately stops the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures

The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as

brachytherapy

What are the 5 most common locations cancer metastasis sites?

brain bone lymph nodes lung liver

Debulking is a reference made when a tumor...

cannot be completely removed, often due to its extension far into healthy tissue

The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is

cell-cycle nonspecific Antitumor antibiotics are cell-cycle nonspecific; they interfere with deoxyribonucleic acid (DNA) synthesis by binding with the DNA. They also prevent ribonucleic acid synthesis. Other cell-cycle nonspecific drugs include nitrosoureas and hormonal agents

Most clients receive ____________________before undergoing bone marrow transplantation

chemotherapy

occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site

extravasation

a tumor can metastasize to other areas of the body by what methods?

gaining access to blood and lymphatic channels

The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of

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

A decrease in circulating WBCs is referred to as

leukopenia

Which types of cancer have the highest prevalence among both men and women?

lung and colon

TPN is given by way of a

peripherally inserted central catheter (PICC) If malabsorption is severe, or the cancer involves the upper GI tract, parenteral nutrition may be necessary. TPN is given by way of a central line, not a peripheral IV.

A benign neoplasm's rate of growth is usually .......

progressive and slow

Common cancers in men include

prostate, lung, and colon

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with

seizures abnormal reflexes papilledema coma and death

Benign tumors have what characteristics?

slow rate of growth and well-differentiated cells do not invade surrounding tissue do not cause generalized symptoms unless the location of the tumor interferes with the functioning of vital organs

Cancer is frequently treated with a combination of therapies using standardized protocols. The basic methods used to treat cancer are

surgery radiation therapy hyperthermia chemotherapy

Thrombocytopenia is a condition that occurs when

the platelet count in your blood is too low

Malignant neoplasms have what distinguishing features?

undifferentiated cells grow by invasion gain access to the blood and lymph channels to metastasize to other areas of the body