Ch. 15 Oncology

A patient is scheduled for cryoablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse?

"The surgeon is going to use liquid nitrogen to freeze the area." Chapter 15: Management of Patients with Oncologic Disorders - Page 336 Cryoablation is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers. Chemosurgery is the use of medication. Laser surgery is the use of a laser. Radiofrequency ablation is the use of thermal energy.

The patient diagnosed with thrombocytopenia is at risk for which of the following adverse effects:

Bleeding Chapter 15: Management of Patients with Oncologic Disorders - Page 377 The patient diagnosed with thrombocytopenia is at risk for bleeding and infection until blood cell counts return to normal. Headache, diminished reflexes, and stomatitis are not adverse effects related to the diagnosis.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?

Control Chapter 15: Management of Patients with Oncologic Disorders - Page 334 The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.

A benign tumor of the blood vessels is a(n)

Hemangioma

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. Chapter 15: Management of Patients with Oncologic Disorders - Page 345, 383 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. Allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior?

Progression Chapter 15: Management of Patients with Oncologic Disorders - Page 326 Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?

Serum potassium level of 2.6 mEq/L Chapter 15: Management of Patients with Oncologic Disorders - Page 383 Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks?

Sun safety and use of sunscreen Chapter 15: Management of Patients with Oncologic Disorders - Page 328 Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.

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 Chemotherapy treats systemic and metastatic cancer. It can also be used to reduce tumor size preoperatively, or to destroy any remaining tumor cells postoperatively. Angiogenesis is the growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth. Fatigue and stomatitis are side effects of radiation and chemotherapy.

Which is a growth-based classification of tumors?

malignancy Chapter 15: Management of Patients with Oncologic Disorders - Page 333 Tumors classified on the basis of growth are described as benign or malignant. Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias.

The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response?

"Benign tumors don't usually cause death." Chapter 15: Management of Patients with Oncologic Disorders - Page 326 Benign tumors remain at their site of development. They may grow large, but their growth rate is slower than that of malignant tumors. They usually do not cause death unless their location impairs the function of a vital organ, such as the brain.

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." Chapter 15: Management of Patients with Oncologic Disorders - Page 361 A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is

"You will need to practice birth control measures." Chapter 15: Management of Patients with Oncologic Disorders - Page 375 Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

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

Administering metoclopramide and dexamethasone as ordered Chapter 15: Management of Patients with Oncologic Disorders - Page 344 The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.

Which occurs when fluid accumulates in the pericardial space and compresses the heart?

Cardiac tamponade Chapter 15: Management of Patients with Oncologic Disorders - Page 631 Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when the superior vena cava is compressed or invaded by a tumor, lymph nodes are enlarged, intraluminal thrombosis obstructs venous circulation, or drainage occurs from the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis that results in thrombosis or bleeding.

A client diagnosed with cancer makes the following statement to the nurse: "I guess I will tell my health care provider 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. Chapter 15: Management of Patients with Oncologic Disorders - Page 344 Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.

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. Chapter 15: Management of Patients with Oncologic Disorders - Page 378 The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.

An oncology nurse is caring for a client who relates that certain tastes have changed. The client states that "meat tastes bad." What nursing intervention can be used to increase protein intake for a client with taste changes?

Encourage eating cheese, eggs, and legumes Chapter 15: Management of Patients with Oncologic Disorders - Page 364 The nurse encourages the clients with taste changes to eat cheese, eggs, and legumes. Encouraging the client to take in the maximum amount of fluids does not increase protein intake. The nurse advises the client to drink protein beverages. Sucking on hard candies during treatment does not increase protein intake.

A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client?

Fear Chapter 15: Management of Patients with Oncologic Disorders - Page 375 Fear of the unknown is probably the major concern for this client. This includes fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual Dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Grieving would not be a likely response at this time.

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 Chapter 15: Management of Patients with Oncologic Disorders - Page 329 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.

A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client?

Wear personal protective equipment when handling blood, body fluids, and feces. Chapter 15: Management of Patients with Oncologic Disorders - Page 348 Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Placing incontinence pads in the regular trash container and providing a urinal or bedpan don't protect the nurse caring for the client.

A client without symptoms receives a diagnosis of prostate cancer after a routine physical. What factors contributed to this diagnosis? Select all that apply.

client history risk factors tumor markers Chapter 15: Management of Patients with Oncologic Disorders - Page 333 The health care provider, using information obtained during the history and physical examination, selects tests that help to establish a diagnosis. Specific cancers alter the chemical composition of blood and other body fluids. Specialized tests have been developed for specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The use of sunscreen would be part of a skin cancer diagnosis.

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy?

fever Chapter 15: Management of Patients with Oncologic Disorders - Page 345 The effects of chemotherapy two weeks after treatment can result in a fever. Regrowth of hair after alopecia can result in change of hair color, but this effect is not anticipated 2 weeks after treatment. White blood cell count will be decreased 2 weeks after chemotherapy. Constipation is not usually seen 2 weeks after chemotherapy treatment.

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type oterm-71f surgery would the nurse include in teaching?

prophylactic Chapter 15: Management of Patients with Oncologic Disorders - Page 337 Also called preventive surgery, prophylactic surgery may be done when there is a family history or genetic predisposition, ability to detect cancer at an early stage, and client acceptance of the postoperative outcome. Local excision is done when an existing tumor is removed along with a small margin of healthy tissue. Palliative surgery relieves symptoms. Cryoablation uses cold to destroy cancerous cells.

The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years?

Colonoscopy Recommendations for screening for colorectal cancer include a screening colonoscopy every 10 years. Fecal occult blood tests should be completed annually in people over age 50. The test for PSA is used as a screening tool for prostate cancer. A Pap test is a screening tool for cervical cancer.

A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis?

Provide a solution of viscous lidocaine for use as a mouth rinse. Chapter 15: Management of Patients with Oncologic Disorders - Page 357 To decrease the pain of stomatitis, the nurse should provide a solution of viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection, but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.

Which oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)?

Syndrome of inappropriate antidiuretic hormone release (SIADH) Chapter 15: Management of Patients with Oncologic Disorders - Page 345 SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis, which results in thrombosis and bleeding. Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

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.

While doing a health history, a client tells the nurse that her mother, her grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse?

"Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." Chapter 15: Management of Patients with Oncologic Disorders - Page 334 Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The nurse cannot say that cancer can be avoided with healthy behaviors; this is inaccurate information. A family history is a reason for the client to be concerned. Cancer does not skip a generation; this response minimizes and negates the client's concern.